Contact me if you want the presentation ahmad.thanin@outlook.com

1. Healthcare
Operational
Management
AHMAD THANIN

2. OBJECTIVES
Define
operations
management
Explain the
distinction
between
goods and
services
Explain the
difference
between
production
and
productivity.
Compute
single-factor
productivity
Identify the
critical
variables in
enhancing
productivity

3. Operations Management
Operations management (OM) is the set of activities that create value in the form of
goods and services by transforming inputs into outputs.
OM is one of three major functions of any organization; we want to study how people
organize themselves for productive enterprise.
We want (and need) to know how goods and services are produced.
We want to understand what operations managers do.
OM is such a costly part of an organization

4. What is
Operations
Management
in health care?
Operations management is the overall coordination of
processes required for the creation and distribution of
products and services. For example, managing costs
while delivering quality services is a major component
of healthcare operations management.
Health care operations are certain administrative,
financial, legal, and quality improvement activities
of a covered entity that are necessary to run its
business and to support the core functions of
treatment and payment.

5. What are the
core functions
of operations
management?
Planning, Scheduling.
Purchasing. Controlling.
Quality
Control
Inventory
Control

6. General Functions and Roles in Healthcare Operations
Management
Planning, Planning
information systems
Managing projects
Helping to design and
develop services
Managing inventory
through the supply chain
Optimizing quality
control
Conducting
procurement/purchasing
Managing logistics
Managing and
maintaining facilities
Conducting enterprise
resource planning (ERP)
Forecasting for planning
Planning for capacity
Navigating industrial
labor relations
Analyzing the value
chain
Optimizing resource
usage
Eliminating waste and
bottlenecks
Continuously improving
processes
Executing a company’s
strategic plan

7. 10 Decision Areas of Healthcare OM
Design of
Services.
Quality
Management.
Process and
Capacity
Design.
Location
Strategy.
Layout Design
and Strategy.
Human
Resources and
Job Design.
Supply Chain
Management.
Inventory
Management.
Scheduling Maintenance

8. The Strategic Decisions
• Defines what is required of operations
• Product design determines quality, sustainability and human resources
Design of Services
• Determine the customer’s quality expectations
• Establish policies and procedures to identify and achieve that quality
Managing Quality

9. The Strategic Decisions
• How is a service produced?
• Commits management to specific technology, quality, resources, and
investment.
Process and Capacity Design
• Nearness to customers, suppliers, and talent.
• Considering costs, infrastructure, logistics, and government.
Location Strategy

10. The Strategic Decisions
• Integrate capacity needs, personnel levels, technology, and inventory
• Determine the efficient flow of materials, people, and information.
Layout Strategy
• Recruit, motivate, and retain personnel with the required talent and skills.
• Integral and expensive part of the total system design.
Human Resources and Job Design

11. The Strategic Decisions
• Integrate supply chain into the firm’s strategy.
• Determine what is to be purchased, from whom, and under what conditions.
Supply-Chain Management
• Inventory ordering and holding decisions.
• Optimize considering customer satisfaction, supplier capability, and production
schedules.
Inventory Management

12. The Strategic Decisions
• Determine and implement intermediate- and short-term schedules.
• Utilize personnel and facilities while meeting customer demands.
Scheduling
• Consider facility capacity, production demands, and personnel.
• Maintain a reliable and stable process.
Maintenance

13. Major Challenges of Hospital
Financial
Challenges.
Patient
Safety.
Government
Mandates.
Access to
Care.
Facility
Security.
Technology
Upgradation.
Personal
Shortages

15. The Input-
Output Model
If we want to improve
outputs, we must
increase inputs
If we want to increase
patient volume in a
clinic By 20%, we need
more personnel, space,
advertising, etc.
If we want to improve
(decrease) waiting time
for patients, we need
more personnel and
equipment

17. Strategies of
Operations
Management
Operations management functions as the
company’s engine room.
Since operations managers are involved in
many roles and functions, they have developed
several important strategies and tactics to
ensure the smooth implementation of their
obligations and responsibilities.

18. The main
strategic and
tactical
methods
Leveraging Data
• Savvy operations managers depend on quality, accurate, and reliable
data for planning, strategic marketing and decision making.
• Two types of data analysis commonly used are efficiency and
effectiveness metrics.
Controlling Data Challenges
• Sometimes, data can be very large, and the results vary, making it
difficult to compare.
• Fortunately, with the help of advanced systems and software,
managers can see, manage and analyze data more easily and
organized.
Analyzing Inventory
• The inventory will easily analyze if the company uses inventory
management software.
• This tool will also make it easier for managers to categorize their
products (known as the ABC analysis).

19. The main
strategic and
tactical
methods
• Operations managers work hard in making the best
research, accurate estimates, and the right development of
good processes.
• All these efforts will eventually lead to long-lasting results
Designing Processes
• Setting goals provides direction and motivation to the
company and its employees.
• Forecasting gives hope as well as provides an opportunity
for the company to prepare for bad results.
• Forecasting requires complete and accurate historical data.
Forecasting and Setting Goals
• Collaboration between departments is needed so that the
finance, marketing and human resources teams can work
together in harmony to make improvements for the
company.
• Any ERP system enables inter-departmental collaboration
by providing centralized information for all departments,
making communication easier and more transparent.
Collaboration Between Departments

20. The main
strategic and
tactical
methods
• Being responsible for the environment as
well as the communities that are directly
affected by the business are the main
concerns that must be taken care of by the
company.
• This is especially true for services that often
deal with medical waste issues.
Social Responsibility
• Managing employees is very important for
your business success since employees are
the backbone of your company
• Without these people, daily business
activities will cease, and your company won’t
be able to produce quality goods or services.
HR Management

21. Strategies of Operations Management

22. The health information system
• (HIS) is broadly defined as a system that
integrates data collection, processing,
reporting, and use of the information
necessary for improving health service
effectiveness and efficiency through
better management at all levels of
health services.

23. Importance of a Health Information System
Produces information needed by
• Patients, communities, service providers,
programme managers, policy-makers,
providers of funds, global agencies and
organizations
Information used for
• Better management, assess coverage and
quality of services; costs and expenditures.
• Detect and control emerging and endemic
health problems
• Monitor progress towards health goals; and
promote equity.
• Strengthen the evidence base for effective
health policies.
• Improve management related to mobilizing
new resources and ensure accountability of
their use.

24. Definition of Enterprise Resource Planning
(ERP)
ERP stands for "Enterprise
Resource Planning" and refers to
a type of software or system
used by a business to plan and
manage daily activities such as
Enterprise Resource Planning
software can be used to
automate and simplify individual
activities across a business or
organization, such as
• Supply chain
• Manufacturing
• Services
• financials and other processes.
• Accounting
• Procurement
• project management
• customer relationship management
• risk management
• Compliance
• supply chain operations.

25. What is
medical
practice
management
software?
Medical practice management software is
designed to help medical facilities run more
efficiently.
It’s a technology solution that can be used for
scheduling appointments, tracking
appointment times, managing billing cycles
and organizing patient information.
it allows healthcare organizations to stay
organized and ensure high-level patient care.

26. Electronic
Medical
Record
(EMR)
An electronic record of health-related
information on an individual that can be
created, gathered, managed, and
consulted by authorized clinicians and
staff within one health care organization.
Can facilitate workflow and improve the
quality of patient care and patient safety

27. What are the benefits of health information system?
Promoting quality
of care through
optimized access
to and adherence
to guidelines
Tracking, and
reporting
Improving
medication safety
Facilitating
communication
between health
care providers

28. Operation
Management
Strategies for
Competitive
Advantage
Differentiation – better, or at least
different.
Cost leadership – cheaper.
Response – more responsive

29. Operations
Management
Decision
Making
Models.
Quantitative approaches.
Performance metrics.
Analysis of trade- offs.
System approach
Establishing priorities
Ethics

30. Models
Modeling is a key tool used by all
decision makers.
• an abstraction of reality; a simplification of
something.
Common features of models:
• They are simplifications of real-life phenomena
• They omit unimportant details of the real-life
systems they mimic so that attention can be
focused on the most important aspects of the
real-life system

31. Type of
Models
• Look like their real-life counterparts.
Physical Models
• Look less like their real-life counterparts
than physical models
Schematic Models
• Do not look at all like their real-life
counterparts
Mathematical Models

32. Understanding Models
Keys to
successfully
using a model
in decision
making
What is the purpose?
How is it used to generate results?
How are the results interpreted
and used?
What are the model’s assumptions
and limitations?

33. Benefits of
Models
Models are generally easier to use and less expensive than
dealing with the real system.
Require users to organize and sometimes quantify
information.
Increase understanding of the problem.
Enable managers to analyze “What if?” questions.
Serve as a consistent tool for evaluation and provide a
standardized format for analyzing a problem.
Enable users to bring the power of mathematics to bear on
a problem.

34. Limitations of
Models
Quantitative information may be emphasized
at the expense of qualitative information.
Models may be incorrectly applied, and the
results misinterpreted
• This is a real risk with the widespread availability of
sophisticated, computerized models are placed in the
hands of uninformed users.
The use of models does not guarantee good
decisions.
Nonqualified users may not comprehend the
rules on how to use the model

35. Quantitative
Methods
A decision-making approach that
frequently seeks to obtain a
mathematically optimal solution:
• Linear programming
• Queuing techniques
• Inventory models
• Project models
• Forecasting techniques
• Statistical models

36. Performance
metrics &
Analysis of
trade- offs
• All managers use metrics to manage and
control operations:
• Profits, costs, productivity and forecast
accuracy.
Performance Metrics
• A trade off is giving up one thing in return
for something else.
• Carrying more inventory (an expense) in
order to achieve a greater level of
customer service.
Analysis of Trade – Offs

37. Systems
Approach
System - a set of interrelated parts that must work
together
The business organization is a system composed of
subsystems
• marketing subsystem
• operations subsystem
• finance subsystem
• Medical Record System
The systems approach
• Emphasizes interrelationships among subsystems
• Main theme is that the whole is greater than the sum of its parts
• The output and objectives of the organization take precedence
over those of any one subsystem

38. Establishing Priorities
In nearly all cases,
certain issues or items
are more important than
others
Recognizing this allows
managers to focus their
attention to those efforts
that will do better
Pareto Phenomenon
•a few factors account for a high percentage of
occurrence of some event(s)
•80–20 Rule: 80% of problems are caused by
20% of the activities.
•The critical few factors should receive the
highest priority
•This is a concept that is appropriately applied
to all areas and levels of management

39. Ethical Issues in Operations
Ethical issues
arise in many
aspects of
operations
management:
Financial statements
Worker safety
Product safety
Quality
The environment
The community
Hiring and firing workers
Closing facilities
Workers rights

40. Ten Steps to
Close the Gap
• Care based on continuous healing relationships.
• Customization based on patient needs and values.
• The patient as the source of control.
• Shared knowledge and the free flow of information.
• Evidence-based decision making.
• Safety as a system property.
• The need for transparency
• Anticipation of needs.
• Continuous decrease in waste.
• Cooperation among clinicians.

41. Care based on
continuous
healing
relationships
Patients should receive care whenever they
need it and, in many forms, not just face-to-
face clinic visits. ( home healthcare,
telemedicine)
This rule implies that the healthcare system
should be always responsive (24 hours a day,
every day), and that access to care should be
provided over the Internet, by telephone, and
by other means in addition to face-to-face
visits

42. Customization based on patient needs and
values
The system of care
should be designed
to meet the most
common types of
needs but have the
capability to respond
to individual patient
choices and
preferences.

43. The patient as
the source of
control
Given all relevant information and the
opportunity to exercise whatever
degree of control they choose over
healthcare decisions that affect them.
The health system should be able to
accommodate differences in patient
preferences and encourage shared
decision making.

44. Shared
knowledge and
the free flow
of information
Patients should have unfettered
access to their own medical
information and to clinical
knowledge.
Clinicians and patients should
communicate effectively and
share information.

45. Evidence-
based decision
making
Patients should receive care
based on the best available
scientific knowledge.
Care should not vary illogically
from clinician to clinician or
from place to place.

46. Safety as a
system
property
Patients should be safe from
injury caused by the care
system.
Reducing risk and ensuring
safety require greater attention
to systems that help prevent
and mitigate errors.

47. The need for
transparency
The healthcare system should make available
to patients and their family's information that
allows them to make informed decisions when
selecting a health plan, hospital, or clinical
practice, or when choosing among alternative
treatments.
This should include information describing the
system’s performance on safety, evidence-
based practice, and patient satisfaction

48. • The health system should anticipate patient needs rather than simply
react to events.
Anticipation of needs.
• The health system should not waste resources or patient time.
Continuous decrease in waste.
• Clinicians and institutions should actively collaborate and
communicate to ensure an appropriate exchange of information and
coordination of care.
Cooperation among clinicians.

49. Metrics to Measure Performance from the
Financial Perspective
Percent of
budget—revenue
Percent of
budget—expense
Days in accounts
receivable
Days of cash on
hand
Collection rate
Return on assets
Expense per
relative value unit
(RVU)
Cost per surgical
case
Case-mix index Payer mix
Growth, revenue,
expense, and
profit—product
line
Growth, revenue,
expense, and
profit—
department
Growth, revenue,
and cost per
adjusted patient
day
Growth, revenue,
and cost per
physician full-time
equivalent (FTE)
Price
competitiveness
on selected
services
Research grant
revenue

50. Metrics to
Measure
Performance
from the
Customer
Perspective
• By service, type, and physician.
• Turnover—new patients and those exiting the system.
Patient care volumes
• Referral and admission rates.
• Satisfaction.
• Availability of resources (e.g., operating suite time).
Physician
• Readmission rates.
• Complication rates.
• Compliance with evidence-based guidelines.
• Medical errors
Clinical Measures

51. Metrics to
Measure
Performance
from the
Customer
Perspective
• Patient Satisfaction
• Waiting Time.
• Cleanliness – Ambience
• Ease of navigation
• Parking
• Billing Complaints
Customer Services
Reputation
Market Share by Product line.
Price Comparisons relative to competitors

52. Metrics to
Measure
Performance
from the
Operational
Perspective
• Average length of stay—case-mix adjusted.
• FTE/adjusted patient day.
• FTE/diagnosis-related group (DRG).
• FTE/RVU.
• FTE/clinic visit.
• Waiting time inside clinical systems.
• Access time to appointments.
• Percent value-added time.
• Utilization of resources (e.g., operating room, imaging suite).
• Patients leaving emergency department without being seen.
• Operating room cancellations.
• Admitting process performance.
• Billing system performance.
• Medication errors.
• Nosocomial infections.
• National Quality Forum (2002) “never events”

53. Undesirable health care situations
An emergency department has average wait time of 80 minutes for nurse examination and 6 hours for discharge or hospital
admission, hardly “emergency support.”
Patient customer feedback surveys indicate an average 3.9 satisfaction level, with scale of 0 (fully dissatisfied) to 7 (fully
satisfied).
A hospital’s surgical complication rate has been “worse than the national rate” for the last three assessments.
The gastroenterology ward “can’t go a day” without an accidental needle stick…and all the related medical follow-up,
documentation, stress, and very real health risks.
A state inspection identified serious flaws in the hospital’s biohazard waste program.
Nursing staff members complain of endless—or not enough—overtime.
A department’s operating costs have increased by 15% year-on-year, without clear explanation of the reason(s).

54. What is a good bed occupancy rate?
Market data from
universal database,
resulting from
comprehensive global
research on this KPI,
indicates that 85-
90% is the ideal range
for % Hospital bed
occupancy rate,
as a rate higher than
90% may induce the
danger of
overcrowding,
indicating that
hospitals may have to
turn away patients
and postpone the
provision of ...

55. Six Skills of
Effective CEOs
Getting Results Creating Culture Attracting Talent
Driving Innovation Setting Strategy Communicating
with Stakeholders

56. The Modern Health Care and Business Environment
New managerial approaches are needed
Why?
• Massive increases in health care costs
• Rapid changes in the business environment
• Transition from sellers’ market to buyers’ market

57. What is a
Sellers’
Market?
Supplier or service provider
largely dictates terms
• Customer is charged for full costs
plus a reasonable profit.
• Response time: We are doing our
best
• Quality: We are doing our best
• Performance: We know what our
customers need
Today’s business market is
more of a buyers’ market

58. What is a
Buyers’
Market?
A buyers’ market is characterized by
• Globalization of the world economy
• Fierce competition
• Global excess capacities (production, services, etc.)
• New managerial approaches
• Access to data and knowledge
• Cheap and rapid communication
• Timely availability of materials and services
• Ease of global travel and transport
• Advanced technologies for production
• Extensive use of advanced IT & communications
• Shortened life cycles of products and services
• Customer empowerment

59. What is a Buyers’ Market?
Price
Determined by
the market
Response
time
Determined by
response time of
best in the market
Quality
Determined by
quality of best in
the market.
Performance
Driven by
customers

60. The Health Care Market
In health care today, demand for services is up while budgets are being reduced
Customers know more
Customers demand more
Technology is developing rapidly
Life expectancy is increasing

61. System Optimization and Suboptimization
The performance of the whole system depends on a few factors like the
system constraints
In a hospital, the operating rooms are often system constraints or bottlenecks
If every subunit in an organization strives to function optimally, the entire
organization may suffer
This is called suboptimization or local optimization

62. Example of
Suboptimization
Purchasing Dept. in Hospital
was judged based on
purchasing costs
It bought lower-cost, inferior-
quality products
Clinical and service failures
resulted along with repeat
hospitalizations

63. The Optimizer
Optimizer:
A decision maker who
wants to make the best
possible decision without
consideration of time
constraints
To reach the
optimal decision
One must generate all
alternatives
Gather all the information
Build a model that will
evaluate the alternatives
Choose the best one
This requires time,
effort, and money

64. Challenges for the Optimizer
Building the optimal model to evaluate alternatives is time and labor-intensive
The optimizer may find the perfect solution, but it may come too late
In a dynamic world, changes are frequent
Timely decisions must be made
This makes life challenging for the optimizer

65. The Pareto Rule, Focusing Table and Focusing Matrix
Pareto discovered that approx. 20% of the population has approx. 80% of
world wealth
This is called the “20-80 rule” and it describes many phenomena
20% of the patients in a hospital ward consume 80% of caregivers’ time
20% of patients consume 80% of medications

66. Other Examples of the Pareto Rule
20% of medications account for 80% of pharmaceutical costs
20% of laboratory tests account for 80% of laboratory costs
20% of suppliers provide about 80% of the value of products, materials, and
components
20% of hospital inventory items constitute about 80% of the total inventory
value

67. ABC Classification
20% of factors are responsible for 80% of outcomes
Group A
30% of factors are responsible for 10% of outcomes
Group B
50% of factors are responsible for 10% of outcomes
Group C

68. ABC Classification: An Example
Group A:
20% of patients in
a ward account
for 80% of ward
expenses
Group B:
30% of patients in
a ward account
for 10% of ward
expenses
Group C:
50% of patients in
a ward account
for 10% of ward
expenses

69. Pareto Analysis of Drug Use in a Hospital

70. Pareto Analysis of Drug Use in a Hospital

71. Pareto Diagram of Analysis of Drug Costs

72. Classification of
Suppliers by
Purchasers
• Group A suppliers: The big
suppliers are 20% of all suppliers
and account for 80% of the dollar
value of all purchases
• Group B suppliers: The 30%
medium-size suppliers account
for 10% of the total value of
purchases
• Group C suppliers: The small
suppliers constitute 50% of all
suppliers but only 10% of
purchase value

73. A Differential Policy for Each
Supplier Group
Group A suppliers: Comprehensive negotiations at the beginning of
the year, detailed negotiations on the largest purchasing orders
throughout the year
Group A
Group B suppliers: A group of selected suppliers will be chosen,
comparative price follow-up performed periodically
Group B
Group C suppliers: Price discounts will be negotiated annually
Group C

74. Resource Allocation
Most resources should be devoted to negotiations
with group A suppliers
Few resources should be invested in dealing with
group B suppliers
Group C suppliers will be evaluated occasionally
It may not always make sense to focus on
monetary contribution --one alternative is item
criticality

75. What is Forecasting?
Process of
predicting a
future event
Underlying basis
of all business
decisions
Production
Inventory
Personnel
Facilities

76. Forecasting
Time
Horizons
• Up to 1 year, generally less than 3 months
• Purchasing, job scheduling, workforce levels,
job assignments, production levels
Short-range forecast
• months to 3 years
• Sales and production planning, budgeting
Medium-range forecast
• +3 years
• New product planning, facility location,
research and development
Long-range forecast

78. Seven Steps in Forecasting
Determine the
use of the
forecast
Select the items
to be forecasted
Determine the
time horizon of
the forecast
Select the
forecasting
model(s)
Gather the data
needed to make
the forecast
Make the
forecast
Validate and
implement
results

79. Forecasting Approaches
Qualitative Methods
Quantitative Methods

80. Qualitative Methods
• New products
• New technology
Used when situation is vague and little data exist
• e.g., forecasting sales on Internet ( telemedicine consultations)
Involves intuition, experience

81. Overview of Qualitative Methods
Jury of Executive
Opinion
Method:
• A method of forecasting using a composite
forecast prepared by a number of individual
experts.
• Involves small group of high-level experts and
managers.
• Group estimates demand by working together.
• Combines managerial experience with statistical
models.
• Relatively quick
• ‘Group-think’ disadvantage

82. Benefits of Jury of executive
opinion
Quick and
easy method.
Pool's opinion
of
experienced,
well-informed
people.
For a young
company, it
may be the
only way.
When
statistics are
missing, there
can be no
other option

83. Overview of Qualitative Methods
Delphi Method
• Iterative group process, continues until consensus is
reached.
• 3 types of participants:
• Decision makers: Evaluate responses and make decisions
• Staff: Administering survey
• Respondents: People who can make valuable judgments

84. Overview of Qualitative Methods
Sales Force Composite
•Each salesperson projects his or her sales
•Combined at district and national levels
•Sales reps know customers’ wants
•May be overly optimistic

85. Overview of Qualitative Methods
Market Survey
• Ask customers about purchasing plans
• Useful for demand and product design and
planning
• What consumers say, and what they actually do
may be different
• May be overly optimistic

86. Quantitative Methods
Used when situation is ‘stable' and historical data exist
• Existing products
• Current technology
Involves mathematical techniques

87. Overview of Quantitative Approaches
Time series
models
Naive
approach.
Moving
averages.
Exponential
smoothing
Associative
model
Trend
projection
Linear
regression

88. Time-Series Forecasting
Set of evenly spaced numerical data
• Obtained by observing response variable at regular time periods
Forecast based only on past values; no other variables
important.
• Assumes that factors influencing past, and present will continue
influence in future

89. Trend Component
Persistent, overall upward or downward
pattern
Changes due to population, technology,
age, culture, etc.
Typically, several years duration

90. Time-Series
Components
Trend
Cyclical
Seasonal
Random

91. Seasonal
Component
Regular pattern of up
and down fluctuations
Due to weather,
customs, etc.
Occurs within a single
year
PERIOD
LENGTH
“SEASON”
LENGTH
NUMBER OF “SEASONS” IN
PATTERN
Week Day 7
Month Week 4 – 4.5
Month Day 28 -31
Year Quarter 4
Year Month 12
Year Week 52

92. Cyclical
Component
Repeating up and down
movements
Affected by business cycle,
political, and economic factors
Multiple years duration
Often causal or associative
relationships

93. Random
Component
Erratic, unsystematic, ‘residual’
fluctuations
Due to random variation or
unforeseen
events
Short duration and nonrepeating

94. Naive Approach
Assumes demand in next period is the same as demand in most
recent period
• e.g., If January sales were 68, then February sales will be 68
Sometimes cost effective and efficient
Can be good starting point

96. Forecasting in the Service Sector
Presents unusual
challenges
Special need for short term
records
Needs differ greatly as
function of industry and
product
Holidays and other
calendar events
Unusual events

97. Bottleneck Analysis and the Theory of Constraints
Each work area can have its own unique capacity
Capacity analysis determines the throughput capacity of workstations in a
system
A bottleneck is a limiting factor or constraint
A bottleneck has the lowest effective capacity in a system

98. Bottleneck Analysis and the Theory of Constraints
The bottleneck time is the time of the slowest workstation (the one that takes the longest) in a
production system.
The throughput time is the time it takes a unit to go through production from start to end

99. Theory of Constraints
Five-step process for recognizing and managing limitations
Step 5 Once overcome, go back to Step 1 and find new constraints
Step 4 Reduce the effects of constraints by offloading work or expanding capability
Step 3 Focus resources on accomplishing Step 2
Step 2 Develop a plan for overcoming the constraints
Step 1 Identify the constraints

100. Bottleneck Management
Release work orders to the system at the pace of or set by the bottleneck
Lost time at the bottleneck represents lost time for the whole system
Increasing the capacity of a non-bottleneck station is a mirage
Increasing the capacity of a bottleneck increases the capacity of the whole
system

101. Thank you
Ahmad Thanin