Lean business models in healthcare: a systematic review

Pursuing sustainable performance in healthcare organizations: a sustainable business model perspective

PURPOSE

This paper explores the use of Dynamic Business Modeling for Sustainability (DBMfS) in healthcare management settings as a holistic approach to integrating economic, social, and environmental dimensions into the business formula of these complex organizations.

DESIGN/METHODOLOGY/APPROACH

After framing sustainable value in healthcare in terms of organizational complexity, wicked problems, and emerging managerial challenges, the paper proposes and illustrates the DBMfS approach that adopts a systemic view of sustainable value in healthcare. According to a qualitative perspective, a single-case study of a maternity-related healthcare treatment is also described to explore the implications and limitations of using this approach to sustainable business modeling in healthcare organizations.

FINDINGS

Findings show that, by embracing sustainability through DBMfS, healthcare organizations can improve operational efficiency, reduce waste (like energy, water, and medical supplies), and enhance cost-effectiveness, thus contributing significantly to societal well-being.

ORIGINALITY/VALUE

In recent years, the healthcare sector has faced numerous challenges and wicked problems, including escalating costs, resource constraints, and growing environmental concerns. As a result, the concept of sustainability has gained significant attention, thus calling scholars and practitioners to develop methods and tools able to integrate it into strategic management systems of healthcare organizations. By proposing the adoption of DBMfS in the healthcare sector, this paper contributes to feeding up the current debate.

The use and application of Lean Management methods to research processes-a scoping review protocol

INTRODUCTION

Waste in medical research is a relatively well-known issue. However, only a few initiatives exist to address this issue. Lean Management methods (Lean) were developed in industrial manufacturing and later applied within healthcare improvement. Overall, the results from studies of the application of Lean to healthcare appear to be positive in terms of greater efficiency regarding treatment outcomes and patient care. Nevertheless, the application of Lean to improve research processes is not well studied and, given that research alongside clinical practice and experiential knowledge provides the foundation for the treatment and care of patients, it is paramount to identify approaches and review the degree to which they increase efficiency within research procedures. Therefore, this review will scope the landscape of studies that investigated Lean and how to implement Lean in research processes, particularly regarding healthcare research.

METHODS AND ANALYSIS

Our approach follows the methodological framework of Arksey and O'Malley for conducting scoping reviews (PRISMA-ScR). The search strategy for this scoping review was developed using the PCC model. We will identify the relevant literature by searching four search databases: Scopus, Web of Science, Academic Search Premier and Business Source Complete. Next, we will use citation pearl growing to identify all relevant published literature. The data charting process will follow the PRISMA-ScR checklist and will be organised using NVivo. We will generate qualitative and quantitative assessments of the extracted data by using NVivo, RStudio and Excel. We will follow the PRISMA-ScR guideline when reporting the results.

ETHICS AND DISSEMINATION

The review will comprise existing published studies and no primary data will be collected. Our findings will be shared through open access peer-reviewed journals, national and international conferences and emails to all relevant collaborative relationships. We plan to disseminate our findings via academic social media platforms, newspaper articles and blogposts.

Disparities in the Timeliness of Addressing Patient-Initiated Telephone Calls in a Primary Care Clinic: The Impact of Quality Improvement Interventions

A timely response to patient-initiated telephone calls can affect many aspects of patient health, including quality of care and health equity. Historically, at a family medicine residency clinic, at least 1 out of 4 patient calls remained unresolved three days after the call was placed. We sought to explore whether there were differential delays in resolution of patient concerns for certain groups and how these were affected by quality improvement interventions to increase responsiveness to patient calls. A multidisciplinary team at a primary care residency clinic applied Lean education and tools to improve the timeliness of addressing telephone encounters. Telephone encounter data were obtained for one year before and nine months after the intervention. Data were stratified by race, ethnicity, preferred language, sex, online portal activation status, age category, zip code, patient risk category, and reason for call. Stratified data revealed consistently worse performance on telephone encounter closure by 72 hours for Black/African American patients compared to Hispanic and non-Hispanic White patients pre-intervention. Interventions resulted in statistically significant overall improvement, with an OR of 2.9 (95% CI: 2.62 to 3.21). Though interventions did not target a specific population, pre-intervention differences based on race and ethnicity resolved post-intervention. Telephone calls serve as an important means of patient communication with care teams. General interventions to improve the timeliness of addressing telephone encounters can lead to sustainable improvement in a primary care academic clinic and may also alleviate disparities.

Development of a Data-Centric Design Thinking Process for Innovative Care Delivery

OBJECTIVES

This work aims to improve the quality of care provided to patients by equipping caregivers with comprehensive set of problem-solving tools and competencies. This is achieved through the development of a customized health design process that incorporates both human-centric and data-centric tools.

BACKGROUND

To meet the growing complexity of today's clinical practice, caregivers need to be empowered with the tools and competencies necessary to address the multifaceted challenges they encounter. This has emphasized the need to broaden the traditional role of caregivers as evidence-based practitioners to include being healthcare problem-solvers and innovators who utilize their creative and critical thinking skills.

METHOD

While design thinking (DT) is a popular methodology that fosters caregivers' empathy and creativity, it does not provide tools for evaluating the quality of obtained solutions. To address this gap, a problem-solving process that combines DT and data-centric tools of the Lean Six Sigma method was developed in this work.

RESULTS

The evaluation of this customized design process was based on targeted competencies derived from the six aims of healthcare. The potential benefits are then highlighted through mapping the possible outputs of every phase with the targeted set of caregivers' skills. Additionally, an implementation plan was outlined for a local hospital, showcasing the potential impact this process can have in empowering caregivers with the necessary competencies to create effective and innovative solutions for care delivery.

CONCLUSION

Overall, This unique approach has the potential to contribute to the ongoing effort to transform healthcare into an efficient system that meets the needs of both patients and caregivers.

Exploring the business skills, experiences and preparedness of UK-based private physiotherapists when establishing and developing a physiotherapy business: A hermeneutic phenomenological study

AIM

To explore the business skills, experiences and preparedness of UK-based private physiotherapists when establishing and developing a physiotherapy business.

DESIGN

A hermeneutic phenomenological approach.

PARTICIPANTS

Six UK-based private physiotherapy practice owners were recruited via purposive and snowball sampling.

METHODS

In-depth, semi-structured video interviews (n = 12) were audio-recorded and transcribed. Field notes, respondent validation and a reflexive diary were used. Data underwent line-by-line analysis, identifying codes and themes. Constant comparison of data, codes and themes occurred throughout. Peer review was utilised, and small sections of data and all emerging codes were independently reviewed.

RESULTS

Knowledge acquisition: participants acquired business knowledge from training, external help, and trial-and-error approaches. Improved physiotherapy-related business training was requested. Business skills: Business plans were generally organic or lapsed with time. Success and timing of marketing strategies varied widely. The altruistic nature of many physiotherapists creates difficulties in requesting payments for services. Clinical policies: Lone working risks appeared more weighted towards protecting staff from physical abuse rather than allegations.

CONCLUSIONS

Improved physiotherapy-related business support and guidance may be beneficial. Focusing on word-of-mouth, website marketing, and establishing support networks may benefit practice owners. Greater consideration of the potentially negative implications of lone working, particularly accusations of inappropriate sexual behaviour, is recommended.

Critical analysis of Lean Six Sigma black belt certification courses offered in Brazil

Purpose

This study aims to present an overview and analyze the Lean Six Sigma Black Belt (LSSBB) certifications offered by institutions operating in Brazil.

Design/methodology/approach

This research analyzed LSSBB certification courses offered by 48 institutions in Brazil by comparing the syllabi of the classes to the reference model proposed by the American Society for Quality (ASQ) in the Six Sigma Black Belt Body of Knowledge. This study employed the content analysis technique and hierarchical cluster analysis to analyze the data.

Findings

The results revealed a lack of standardization in the content of Lean Six Sigma (LSS) training in Brazil. 100% of the LSSBB courses analyzed covered four of the 108 techniques recommended by the ASQ Body of Knowledge (i.e. data types, measurement scales, sampling, and data collection plans and methods). In contrast, more than 75% of the courses covered all techniques related to the macro areas of organization-wide planning and deployment, organizational process management and measures, measure, and improve. The major shortcoming of LSS training is related to the macro area Design for Six Sigma framework and methodologies. LSS training is offered in a highly concentrated area in Brazil, the wealthiest region, where universities play a crucial role in disseminating LSS.

Originality/value

The literature lacks studies that critically examine LSS certification courses. There is little research on LSS in Brazil and there are no studies on LSS training in this country.

Lean Six Sigma in Healthcare: A Systematic Literature Review on Challenges, Organisational Readiness and Critical Success Factors

Lean Six Sigma (LSS) has been applied in many healthcare organisations, but there has been limited research on the evolution of LSS application in healthcare. This paper aims to present the challenges, critical success factors (CSFs), readiness factors and most common tools and techniques used for LSS deployment in healthcare. A systematic literature review (SLR) was utilised to research the study objectives. Peer-reviewed literature over a 16-year period was studied to understand the deliverables of LSS. The SLR process identified relevant articles and screened a final selection for those under study. The systematic literature review helped the authors to identify the challenges and tools/techniques used for LSS in healthcare. Several CSFs and readiness factors for LSS deployment in healthcare are also presented. This work informs healthcare managers and professionals on the important factors for successful LSS deployment before embarking on the LSS journey. In addition, this work is a valuable resource for healthcare LSS practitioners and academic researchers to learn about, investigate and deploy LSS in the healthcare sector. This study is one of the most comprehensive SLRs covering the importance and specificity of understanding challenges, CSFs and organisational readiness for LSS in healthcare. This study provides knowledge of the successful deployment of LSS in healthcare.

Lean Six Sigma in Healthcare: A Systematic Literature Review on Motivations and Benefits

While Lean Six Sigma (LSS) has been applied extensively in healthcare organisations, there has been limited research on the trends of LSS application in healthcare in recent years. This paper aims to present the key motivations and benefits of LSS in healthcare with a view to highlighting the types of problems that LSS in healthcare can aid in solving. The authors used a systematic literature review (SLR) approach to achieving the article’s purpose. Peer-reviewed journal articles published between 2011 and 2021 are considered to achieve the study objectives. The systematic review helped the authors to identify the evolution, benefits, and motivations for LSS in healthcare. This work includes directions for managers and healthcare professionals in healthcare organisations to embark on a focused LSS journey aligned with the strategic objectives. This study is perhaps one of the most comprehensive SLRs covering a vital agenda of LSS in healthcare. This study provides all the deliverables of LSS for its successful deployment in healthcare.

Lean Six Sigma case studies literature overview: critical success factors and difficulties

Purpose

Recently, several areas are successfully applying the Lean Six Sigma methodology, specifically in healthcare, public services, higher education institutions and manufacturing industries. This study aims to present an extensive literature review involving Lean Six Sigma practical applications in the last five years, described in a case studies format.

Design/methodology/approach

A systematic literature review was conducted, and 39 articles were selected and analyzed.

Findings

An increase in Lean Six Sigma applications in healthcare and higher education institutions was identified. Furthermore, Lean Six Sigma is effectively applied in several areas and is continuously used in traditional industries. The main critical success factor identified was leadership and management involvement, project management and organizational infrastructure, as well as training and education. Also, the main difficulties found are related to the organization's culture and developing communication with leaders and managers.

Research limitations/implications

The main difficulties found in this research are related to the lack of data presented in some articles analyzed, where only information about how the Lean Six Sigma application was conducted is shown, not mentioning difficulties or success factors identified.

Originality/value

Case studies are fundamental to help popularize Lean Six Sigma applications, showing a real-life scenario of how the methodology is implemented, the main difficulties encountered and critical success factors found. Thus, the value of this study is promoting and developing research involving Lean Six Sigma case study applications to guide new researchers and practitioners on the subject.

A study on how to achieve flexibility in healthcare process: a simulation-based approach

Purpose

The paper aims to investigate the cardiology department’s operational system for improving flexibility by minimizing the patient waiting time and simultaneously maximizing the utilization of service capacity in an uncertain environment. This article also proposes a policy framework that suggests a pool of additional resources and inter-firm collaboration can boost healthcare service delivery excellence.

Design/methodology/approach

A discrete event simulation (DES) approach is followed for modeling patient flow and determining the service capacity to respond to demand variability and uncertainty. The model's outputs are used to minimize patient waiting time, maximize the utilization of the resources and match the service capacity with the patient demand.

Findings

This research has tested two hypotheses and proved that an increase in waiting time decimates the throughput rate, and additional resources deployment in bottleneck activity positively impacts the throughput rate. The simulated scenarios prescribe an enhanced service capacity with quality care and further contribute to operational performance in reduced waiting time and cost. The results indicate that flexibility reduces the patient waiting time and maximizes the throughput rate.

Practical implications

The study guides the healthcare policymakers to develop flexible competence and facilitate service mechanisms that are adaptive and robust while operating under a volatile environment. The article contributes to the healthcare literature that conjoins flexibility through simulation and resource utilization.

Originality/value

This research is based on real-life primary data collected from healthcare providers. This study adds value to the healthcare systems to adopt strategic decisions to build flexibility through resource allocation, sharing and coordinated care.

A framework to guide the implementation of lean management in emergency department

PURPOSE

The paper aims at enriching the knowledge of the application of lean management (LM) in emergency department (ED), structuring the methodology for implementing LM projects and summarizing the relevant dimensions of LM adoption in ED.

DESIGN/METHODOLOGY/APPROACH

In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, a systematic literature review has been performed, extracting a database of 34 papers. To answer the research purpose, a descriptive and content analyses have been carried out.

FINDINGS

The descriptive analysis demonstrates that the dealt topic is worldwide emerging and multidisciplinary as it arouses interest by medical and engineering communities. Despite the heterogeneity in the adopted methodology, a framework can be grasped from the literature review. It points out the phases and activities, the tools and techniques and the enablers to be considered for guiding the developing of LM project in ED.

ORIGINALITY/VALUE

This paper provides a comprehensive overview on how to adopt LM in ED, contributing to fill in the gap emerged in the literature. From a practical perspective, this paper provides healthcare managers with a synthesis of the best managerial practices and guidelines in developing a LM project in ED.