Resident-Driven Holistic Lean Daily Management System to Enhance Care Experience at a Safety Net Hospital

Detecting unexpected scores of individual students in an examination based on past scores and current daily efforts

Purpose

This paper proposes a model for detecting unexpected examination scores based on past scores, current daily efforts and trend in the current score of individual students. The detection is performed soon after the current examination is completed, which helps take immediate action to improve the ability of students before the commencement of daily assessments during the next semester.

Design/methodology/approach

The scores of past examinations and current daily assessments are analyzed using a combination of an ANOVA, a principal component analysis and a multiple regression analysis. A case study is conducted using the assessment scores of secondary-level students of an international school in Japan.

Findings

The score for the current examination is predicted based on past scores, current daily efforts and trend in the current score. A lower control limit for detecting unexpected scores is derived based on the predicted score. The actual score, which is below the lower control limit, is recognized as an unexpected score. This case study verifies the effectiveness of the combinatorial usage of data in detecting unexpected scores.

Originality/value

Unlike previous studies that utilize attribute and background data to predict student scores, this study utilizes a combination of past examination scores, current daily efforts for related subjects and trend in the current score.

Lean Management Systems in Health Care: A Review of the Literature

BACKGROUND AND OBJECTIVES

Many health care organizations now employ Lean tools to improve value in health care, yet reports of their effectiveness vary. This variation may be explained by the context in which Lean is implemented, whether as a tool or as a management system. This article reports on a structured literature review conducted to understand the evidence base for the impact of Lean Management System implementation in health care.

METHODS

A search of PubMed, Scopus, Emerald, EMBASE, CINAHL, and Business Source Complete databases was conducted in November 2017 and repeated in July 2020 to assess the evidence for the impact of Lean Management Systems in health care from 2000 to July 2020. Articles were included if they (1) reported on a Lean Management System or (2) reported on Lean Management System components as described by Mann 1 (ie, leader standard work, visual controls, daily accountability process, and discipline).

RESULTS

A total of 52 articles met the inclusion criteria. Although all articles described some combination of leader standard work, visual management, and daily accountability as part of their Lean Management System, only a handful described use of all 3 components together. Only one explicitly mentioned the fourth component, discipline, required to consistently apply the first 3. The majority reported on single-unit or department implementations and most described daily huddles at the unit level that included review of key performance indicators, identification of improvement opportunities, and problem solving. The role of the leader in a Lean Management System was described a coach and a mentor. Barriers to adoption such as insufficient training and increased workload for nurses were noted along with the importance of relevance to the local context for unit teams to find value in huddle boards and huddles. As yet, evidence of Lean Management System effectiveness in driving health care improvement is absent due to weak study designs and lack of statistical rigor.

CONCLUSION

Well-designed research on Lean Management Systems in health care is lacking. Despite increasing adoption of Lean Management Systems over the past 10 years and anecdotal reports of its effectiveness, very few articles provide quantitative data. Those that do report unit-level implementation only, little use of a comprehensive package of Lean Management Systems elements, and weaker study designs and statistical methods. More rigorous study designs and robust statistical analysis are needed to evaluate effectiveness of Lean Management Systems in health care. This represents a rich area for future health care management research.