Is the hospital lean? A mathematical model for assessing the implementation of lean thinking in healthcare institutions

A fuzzy decision framework of lean-agile-green (LAG) practices for sustainable vaccine supply chain

Purpose

The already-strained vaccine supply chain (VSC) of the expanded program for immunization (EPI) require a more robust and structured distribution network for pandemic/outbreak vaccination due to huge volume demand and time constraint. In this paper, a lean-agile-green (LAG) practices approach is proposed to improve the operational, economic and environmental efficiency of the VSC.

Design/methodology/approach

A fuzzy decision framework of importance performance analysis (IPA)–analytical hierarchy process (AHP)–technique for order for preference by similarity in ideal solution (TOPSIS) has been presented in this paper to prioritize the LAG practices on the basis of the influence on performance indicators. Sensitivity analysis is carried out to check the robustness of the presented model.

Findings

The derived result indicates that sustainable packaging, coordination among supply chain stakeholders and cold chain technology improvement are among the top practices affecting most of the performance parameters of VSC. The sensitivity analysis reveals that the priority of practices is highly dependent on the weightage of performance indicators.

Practical implications

This study's finding will help policymakers reframe strategies for sustainable VSC (SVSC) by including new management practices that can handle regular immunization programs as well as emergency mass vaccination.

Originality/value

To the best of the authors' knowledge, this is the first study that proposes the LAG framework for SVSC. The IPA–Fuzzy AHP (FAHP)–Fuzyy TOPSIS (FTOPSIS) is also a novel combination in decision-making.

Lean six sigma in the healthcare sector: A systematic literature review

Healthcare is a very important sector as our lives depend on it. During the novel corona virus pandemic, it was evident that our healthcare organizations still lack in terms of efficiency and productivity. Especially in the developing nations, the problems were much bigger. Lean Six Sigma (LSS) is a methodology which when implemented in an organization, helps to increase the process capability and the efficiency, by reducing the defects and wastes. The present study systematically reviews the research studies conducted on LSS in the healthcare sector. It was found that comparatively less studies are focused on improving the medical processes, most of the studies targeted the management processes. Moreover, lesser number of studies were being conducted for developing nations, but now it seems that the focus of research scholars has shifted towards the developing nations also. But it was observed that the studies in these nations were majorly empirical in nature, very few studies were conceptual or exploratory. There is a need for guiding healthcare professionals on creating a continuous improvement environment, which sustains the improvements achieved after LSS implementation.

Implementation of Lean Management in a Multi-Specialist Hospital in Poland and the Analysis of Waste

At the beginning of the 21st century, Lean Management (LM) tools were introduced into the healthcare sector around the world. In Poland, there are still few LM implementations, and they are not of a comprehensive nature. The aim of this article is to present the application of the LM concept in a hospital in Poland as a tool for the identification and analysis of waste and its impact on the process of organizing the provision of medical services on the example of improvements in the process of patient admission. In the period from 1 July 2019 to 31 December 2019, a project of LM implementation was carried out at the Provincial Specialist Hospital in Wroclaw. The project was based on the method of value-stream mapping and 5Why. Standardized interviews (before and after the project) were conducted with people from the hospital management and middle-level managers. The implementation of LM tools resulted in the identification of a number of wastes, which have been divided into groups. The most important waste was paper medical documentation. Its change to an electronic form allowed for a better use of human capital resources; savings included 2.3 nursing positions and 1.09 medical staff positions.

Lean Healthcare Implementation: How is The Employee’s Acceptance?

Lean healthcare is a new concept in hospital management that not only focus on patient value but also efficiency. This study aimed to understand how far the employees bring lean healthcare implementation in to their daily work. Lean healthcare phylosophy tend to built a lean culture. This study used a descriptive qualitative study design with lean team in several unit in Panti Rapih Hospital. This study adopted an instrument of Lean in Healthcare Quistionaire which measure four domain principal of lean, they are pylosophy, process, people and partner, and problem solving. Result of this study showed that not all indicators have met the highest level of maturity of lean healthcare implementation. Indicator standardization still low in the iplementation, in the other hand rewarding staff system is Panti rapih Hospital already design and have the haighest score. The management should focus on the improvement of job evaluation process with a certain indicator or procedures. Threfore, the employee’s performance can be improve directly from the result of evaluation.

The first evidence about conceptual vs analytical lean healthcare research studies

PURPOSE

Several authors have examined the lean healthcare literature, but besides all efforts made, articles comparing conceptual and analytical studies were not found. Thus, a systematic review is conducted aiming to understand the state of the art of lean healthcare by investigating and comparing how conceptual and analytical articles address tools/methods, application fields, implementation barriers and facilitators and positive and negative impacts.

DESIGN/METHODOLOGY/APPROACH

Articles in English about lean healthcare, published in journals in the last ten years (2009-2018) and indexed in Web of Science (WoS) or Scopus were examined and assessed by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) protocol. A qualitative content analysis on the eligible articles was conducted, and results from the conceptual and analytical studies were compared.

FINDINGS

There is a literature gap regarding tools/methods in both conceptual and analytical approaches once they prioritize for different items. Barriers, facilitators and negative impacts are perceived differently within both categories and might require more extensive analysis. The same items prevail in both conceptual and analytical categories when analyzing healthcare fields and positive impacts.

ORIGINALITY/VALUE

There is a lack of articles comparing conceptual and analytical studies concerning lean healthcare. So, this study's relevance is in identifying theoretical and applied research gaps to strengthen the lean healthcare state of the art and to integrate theoretical-applied knowledge. For healthcare professionals, it might provide an overview of the key factors that can promote lean implementation.

A lean approach to healthcare management using multi criteria decision making

Recent challenges induced by the global pandemic COVID-19 have highlighted the critical importance of coping with a sudden surge in demand for front line healthcare services. Motivated by the success of lean implementation in manufacturing systems, this study attempts to apply the lean principles in healthcare delivery environments. The lean approach begins with the identification of seven types of wastes in any production or service system. This study attempts to identify and prioritize the present in hospitals. The study contributes to the existing body of knowledge in two ways. First, we identify the various sources contributing to the seven basic wastes in healthcare delivery. Second, we prioritize the seven types of wastes and the dimensions contributing to these wastes using a Multi-Criteria Decision Making (MCDM). This paper used the fuzzy analytical hierarchy process approach, which is a well-accepted tool in MCDM. The study was conducted at select hospitals located in and around Pune city in India. We find that waiting, transportation, motion, and defects are dominant in adopting lean practices among the seven wastes. The findings of this study may guide hospital management in strategic planning in adopting a lean healthcare process. To our knowledge, this is one of the first studies to extract, and prioritise lean wastes within the context of the healthcare sector.

A case-based methodology for lean implementation in hospital operations

PURPOSE

Although there are general methodologies for lean implementation in manufacturing companies, a specific methodology for the implementation of lean healthcare in hospitals has not been addressed by the literature. Addressing this gap, the purpose of this paper is to develop a practice-driven methodology for implementing lean in hospital operations.

DESIGN/METHODOLOGY/APPROACH

Three case studies were conducted to collect evidence on the lean implementation process in Brazilian hospitals. From empirical evidence and literature, the implementation methodology was proposed and submitted to critical assessment by experts from the field.

FINDINGS

The process of lean implementation was very similar in all cases, triggered by strategic planning and operationalized by continuous improvement projects. On the other hand, in all cases, the lean implementation teams had to deal with employees' resistance. These findings were valuable inputs to the development of the implementation methodology. After refinement, it was proposed a feasible, useful and user-friendly methodology.

RESEARCH LIMITATIONS/IMPLICATIONS

The proposed methodology was raised from the practice through case study research. However, the proposed methodology was not fully applied, and the associated performance measures were not elaborated in this paper. Therefore, more case studies and applications will be necessary to generalize the findings.

PRACTICAL IMPLICATIONS

The methodology provides practical guidelines that support lean implementation in hospital operations. Although it demands adaptations for each specific hospital setting, this initial step may encourage hospital managers to start the lean journey.

ORIGINALITY/VALUE

This study addressed the gap in the literature regarding the lack of methodologies for implementing lean healthcare in hospital operations. The methodology synthesizes the knowledge, principles and tools of lean thinking that can be applied in hospital operations.