healthcare system referred that it is the organization of people, institutions, and resources that deliver healthcare services to meet the health needs of target population. A good healthcare system will be able to provide a good healthcare policy for the people as well as for the country. Health care is rich in evidence-based innovations, yet even when such innovations are implemented successfully in one location, they often disseminate slowly-if at all. Diffusion of innovations is a major challenge in all industries including health care. But it is true that the healthcare system in Bangladesh is poor enough than the healthcare system in the developed country. The delivery of safe and high-quality health care has become a crisis in this country in terms of per¬sonal loss due to preventable errors, as well as economic loss. Therefore in this research, the aim is to find out the problems exists in the healthcare system in Bangladesh and then by analysis these problems a better strategic solution or recommendation has been provided. The ultimate goal is to best approach to reduce waste, as well as reducing wait times and unnecessary travel, while building quality, speed, and flexibility in the healthcare organization. A natural impulse to address these challenges is to introduce technology to mitigate risks due to human error and communication. For survey purpose, various regional areas are selected for examining the existing healthcare services and also collected some additional data from other regions in this regard. As a number of healthcare organizations have been surveyed, the collected data are so much complicated and it is difficult to find out the exact defective portion of the existing healthcare system. For this purpose, some set of questioners are used which are based on patient satisfaction and the employee satisfaction. From this survey some problems related with the healthcare system are extracted and possible solution techniques are proposed in this regard.

Healthcare management is a growing profession with increasing opportunities in both direct care and non-direct care settings. As defined by Bookbinder and Thompson (2010, pp. 33-34), direct care settings are "those organizations that provide care directly to a patient resident or client who seeks services from the organization". Non-direct care settings are not directly involved in providing care to persons needing health services but rather support the care of individuals through products and services made available to direct care settings [1][2].

In 2005, the National Academy of Engineering (NAE) and the Institute of Medicine (IOM) 2 highlighted the need for a systems approach to the health care system and the application of systems engineering tools to improve health care [3]. In 2003, the Institute of Medicine's (IOM) report "Crossing the Quality Chasm" recommended the use of systems and industrial engineering techniques to systematically examine and redesign clinical processes. A subsequent National Academy of Engineering report made the same recommendations. Lean is a QI methodology based on systems and industrial engineering techniques. Lean techniques have been empirically documented as highly effective for systems redesign within manufacturing environments. Moreover, ample evidence suggests that appropriately developed and optimized Lean techniques are effective within health care settings [1].Since 2004, therefore giving services in a sector like healthcare without quality is not expected at all. In Bangladesh, healthcare is provided principally through hospitals run by government or through private clinics with a small proportion delivered by NGOs. But the main problem is that, the total system of health care services both in public and private sectors are not up-todate genuinely and again the quantity of the doctors are less than expectation. To overcome this huge problem, redesigning of existing health care system or setting up an influential service plan is a must issue for Bangladesh. Firstly, the concentration in this project will be to discuss the basic problems and analyze them effectively. After that, the follow up will be to find out the most prominent issues both in manpower and management sector according to voice of patient and voice of employee. Lastly, with the basis of limited resources in Bangladesh, Two methods will be set up both in manpower and management which are very much feasible to implement in our health care sector. The ultimate target and research of ours are to create an effective communication or service system between doctors and patients with assuring high level of quality.

faculty from the Purdue University College of Technology, Indiana University-Purdue University Indianapolis (IUPUI)'s School of Engineering and Technology, Purdue University-Calumet College of Technology, the Regenstrief Center for Healthcare Engineering (RCHE), and the Indiana University Center for Health Services and Outcomes Research at the Regenstrief Institute, Inc. have partnered with several Indiana hospitals and hospital systems to create Lean and Six Sigma® health care programs [1]. In 1994 Quality in Australian Health Care Study (QAHCS) was commissioned by the Commonwealth Department of Human Services and Health to determine the proportion of admissions associated with an AE in Australian hospitals [4]. Modern management in the company is not only the quality management system based on the ISO series 9000:2000 standards, but pursuit to the continuous improvement, so this is the philosophy of the Total Quality Management [5]. In the frames of implementation of the Total Quality Management on the operating level more and more popular becomes the idea of so called 5S. The 5S method begins each program of improvement. It is the tool for helping the analysis of processes running on the workplace. The 5S is the methodology of creation and maintaining well organized, clean, high effective and high quality workplace. Its result is the effective organization of the workplace, reduction of work's environment, elimination of losses connected with failures and breaks, improvement of the quality and safety of work [6][7][8]. Lean Manufacturing is the hymn of survival and success of any organization through minimizing the wastage of resources and moving towards implementation of lean manufacturing has become one of the key strategies to achieve cost cutting. The goal of lean manufacturing is to minimize all types of waste or non-value added activity through incorporating less human effort, less inventory, less time to develop product and less space to become highly responsive to customer demand, while at the same time producing good quality products in the most efficient and economical manner. 5S is Lean manufacturing tool for cleaning, sorting, organizing and providing necessary ground work for work place improvement. 5S is already selected using Analytic Hierarchy Process (AHP), a Multi Criteria Decision Making (MCDM) tool by considering different criteria for case company. AHP is a problem solving framework based on the innate human ability to make sound judgment about small problem. It is a quantitative technique use to facilitate decision that involves multiple competing criteria [9].

This research work was based on two public and two private hospitals. Total 80 patients and 20 personnel have been contributed dividing 20 patients and 5 personnel for each hospital. A survey questionnaire has been created based on the issue of patient satisfaction and employee satisfaction. The questionnaire for the patient also divided into three categories focused on treatment, doctor /nurse and employee. The questionnaire for the personnel is all about management related. From this investigation, a lot of problems have been generated but it is too difficult to solve all of them in Bangladesh at this moment rather than finding the major problems to solve.

As the problems are too many to describe, a screening process has been done for finding the most significant problems and evaluating their importance based on patient problems and employee problems.

For any types of industry i.e. healthcare, manufacturing etc., 5M philosophy (manpower, management, machine, material, and measurement) is well known trend for improving productivity and service. After detecting most significant problems, the significant problems have been classified into manpower and management through the relationship diagram.

In the process approaching, a tool has been selected for controlling manpower related problems and then Talent selection and Management has become a key to solution in this regard. This method does not encourage recruiting new personnel but it emphasizes on the training system on existing manpower.

In this case study, the most adaptable quality tool 5S has been implemented in respect of health care industries of Bangladesh. 5S is used to calculate the overall efficiency for different hospitals. The problem parameter has been set up based on the survey report for both patient satisfaction and employee satisfaction. The main reason of this case study is to anticipate the management situation and setting a target goal to improve efficiency of the management based on the result. Here a message has been indicated that continuous improvement can be ensured by maintaining 5Son these hospitals ifthese organizations are agreed to maintain effectively.

IV.

Based on survey analysis, problem screening matrixes have been constructed by following criteria: A relative score of "better than" (+),"same as"(0), or "worse than"(-) is placed in each cell of the matrix to represent how each problem rates in comparison to the reference problem relative the particular criterion. It is generally advisable to rate every problem on one criterion before moving to the next criteria. However with a large number of problems, it is faster to use the opposite-to rate each problem completely before moving on to next problem. Problem screening matrix for Patient problems and employee problems are shown in Table 1. and 2 respectively.

Based on the problem screening matrix six major problems have been identified as high ranked which indicate these problems should be highly focused to improve for better output in the health care system. Moreover, based on the extensive research two critical points are emerged due to system malfunctioning and should be improved by further tools so that overall problems can be resolved or minimized. Relationship diagram for manpower and management are shown in figure 1 and 2 respectively. Lean was chosen as the principal tool set for process redesign as it appeared to best address the major issues observed in the current processes.

Its focus on waste afforded on the healthcare industries as the most opportunity to reduce expenses-a step that was clearly necessary in order to survive in face of growing numbers of uninsured and decreasing revenues. Its focus on value from the customer perspective fit the customer service need. It also fit the organization in that it appeared to require a great deal of presence on the "floor" with observation, substantial intuitiveness, rapid-cycle improvement, and broadbased employee involvement and empowerment.

The challenges faced in the process of implementing and sustain lean is a tedious job as the concept relates to time, cost, interest, and involvement, the concepts that together support the new change for development in an firm [10].

iii. Talent selection and Management was selected as a valuable asset in matching employees with roles. This is particularly significant in health care, an industry that is experiencing shortages and high turnover rates in some health care professions. This method does not encourage recruiting new personnel but it emphasizes the training system on existing manpower. It helps to improve the quality of the existing manpower of healthcare system.

In Bangladesh, all the techniques described earlier can be implemented. But by doing extensive research, the proposed applicable technique for Bangladesh is Talent selection and Management. It is deeply emphasized because of no addition of manpower in the system rather than increase their performance by following guidelines.

Any healthcare organization looking to jumpstart a talent initiative should keep a few things front of mind: Building with an eye toward integration-E-learning may be a natural starting point for healthcare organizations implementing new talent initiatives, but onboarding, performance management and succession initiatives all benefit from strong tie-ins to a Learning Management System (LMS). For example, performance assessments can automatically generate development plans where deficiencies are identified. It should not be overlooked targeted &formal development programs for employee supervisors. Extra training will prepare them to mentor and coach employees and maximize the value of your investment. Automation of job descriptions with a foundation of competencies-Establishing the competencies -the knowledge, skills and behaviors that are used to develop people in your healthcare organization -is a critical step for success of any talent management initiative. In the healthcare setting, it's a requirement because compliance demands it. Maintaining one set of job descriptions and competencies is one way to integrate multiple locations common in large healthcare systems into a single culture and to build job profiles that will guide career development, training and performance improvement across your organization.

as nursing, IT and senior management. Yet, suitable candidates are hard to find. Most healthcare employers understand that the only solution is to "grow their own" talent. Implementing appropriate talent management and learning tools and processes makes identification of high-potential employees and development of critical skills far easier to accomplish.

Collaboration to build a comprehensive succession strategy-Majority of healthcare organizations have a critical need to develop their next generation of leadership. The current senior leaders must understand the critical need to address this gap. HR can -and must -play a crucial role in facilitating this conversation, and technology can provide a key assist to identify the gaps and assign development plans for designated successors [11] Fig. 4: A systematic approaches on Talent Management

Seiri is the first S in 5S system, which is basically deal with the available facilities and process of Healthcare organization management. For calculation of Seiri rating, 5 criterion regions have been chosen for seiri arrangement, and decided that the sub system should be achieved rating (Based on voice of patients) out of 5. The shorting initiative data is shown in Table 3. Following are the Seiri rating criterion.

treatment facility is fully available or giving 0 marks if emergency treatment facility is not fully available.

2) Diagnostic Readiness: Giving 1 mark if diagnostic resources are fully available or giving 0 marks if diagnostic resources are not fully available.

3) Dispensary Inventory: Each of the observation is shown the ratings for dispensary inventory based on patient satisfaction survey report where X is the amount of participation (Total 20 patients) for each healthcare organization and Y is the amount of dissatisfied patients. The fraction of consistency for dispensary inventory is [1-{Y/X}].

Each of the observation is shown the ratings for waste disposal based on patient satisfaction survey report where N is the amount of participation (Total 20 patients) for each healthcare organization and M is the amount of dissatisfied patients. The fraction of consistency for waste disposal is [1-{M/N}].

Each of the observation is shown the ratings for relative Information based on patient satisfaction survey report where A is the amount of participation (Total 20 patients) for each healthcare organization and B is the amount of dissatisfied patients. The fraction of consistency for relative information is [1-{B/A}] Relative Information: Waste Disposal:

Seiton is second S of 5S system which deals with the proper arrangement of equipment and availability of service for each sections in the particular organization. The main objectives of Seiton are forming a regular workplace, avoiding time loss while servicing or delivering the treatment or medic. Set in order Initiative data is shown in Table 4. Following are the Seiton rating criterion: 1) Doctor's Availability: Giving 1 mark if the facility is fully available or giving 0marks if the facility is not fully available. 2) Personnel Availability: Giving 1 mark if the facility is fully available or giving 0 marks if the facility is not fully available.

Seiketsu is generally means for make a peak standard which should be achieved by the normal healthcare management process practice. Standard should be communicative and easy to understand. Seiketsu rating will be found by calculating the average of previous three S, because standard of any system will rise and fall by mean rate depending factors. Standardize/Systematize Initiative data is shown in Table 6. Shitsuke (Sustain) is the last S of the 5S system which is deal with the regularity of maintaining the standard of the organization for the particular process, which is only done by regular practices and by following the proper instruction of system operating. By doing regular following of accurate of instruction it can be maintained the working condition at its peak level, which may help for better service and stay away from breakdown. 1) Removing small faults through the aid of cleaning.

2) Providing the execution of visual control.

3) Providing the performance of protective activities. 4) Granting the responsibility of the treatment of service to the patient 5) Formation of a disciplined environment.

Shitsuke rating will be depending on the previous four S because without that the regularity will not maintain. Therefore Shitsuke rate will be the average of previous four S ratings. Sustain initiative data is shown in Table 7.

Sorting S1

Set In Order S2

Total Rating = (S1+S2+S3) /3 After the calculation of this rating of 5S, the efficiency has been calculated for every observation and this evaluation simplifies the service & quality differences between public and private healthcare organizations. Also a graphical representation has been made which will represent the real condition of the system and can find the improvement required region. The calculated efficiency is shown in Table 8 and figure 5.