Innovations in inpatient flow and bed management

An innovative procedure for introducing the lean concept into the internal drug supply chain of a hospital

Purpose

In a hospital, the management of different materials (i.e. waste, drugs, equipment, etc.) is fundamental from an economical point of view and also when considering its impact on patient treatment. The purpose of this paper is to introduce by an innovative approach lean principles in the management of this supply chain.

Design/methodology/approach

After the contextualization of the importance of the drug management in hospitals, authors analyze the literature in particular discussing the points of weakness. They propose an innovative methodology to implement a lean principle in this particular supply chain. After a general discussion authors discuss the application of the proposed methodology in the largest Italian hospital, the Policlinico Sant’Orsola – Malpighi in Bologna.

Findings

The results are very encouraging, confirm the value of the methods and motivate the authors to do further research. The proposed methodology takes into account both a technical approach and the real behavior of a hospital including logistics knowledge and motivation for material management in ward personnel. Real results are interesting both in term of economic impact and in term of effect on patient care.

Originality/value

Maximizing patient care is the mission of the healthcare system; however, poor management of drugs and materials can have serious effects on the quality of service. In the last years, several excellent technological solutions have been developed, but often their application in the field was limited and ineffective due to the gap in knowledge and commitment required and available in the ward’s personnel. The new methodology developed is focused to solve this gap and was tested in an important case study.

Business Process Re-engineering for Bed Allocation Process in a Tertiary Care Hospital in Mumbai

A proficient bed allotment system in the hospital reflects effective management. Minimizing the waiting time and appropriate bed allocation ensures quality of care and optimum utilization of hospital resources. The hospital management must respond to the growing needs of the patient care by reducing the admission delays and communication delays among health care providers. The objective of the study was to understand the bed allocation process, to evaluate reasons for delay in bed allotment and to minimize the waiting time for new admissions in a 750-bedded tertiary care hospital. The study was conducted by taking a random sample of 35 beds of general category. The admission time was recorded through hospital information system and by interviewing the nursing and housekeeping staff. The study revealed that the delay in communication from nurse station to admission counter was the major reason followed by delay in billing process and delay in preparing bed by the housekeeping staff.

Benefits realisation from IT-enabled innovation

Purpose

The purpose of this paper is to address the call for more public sector empirical studies on benefits realisation (BR), to contribute to the literature on BR as a dynamic capability (DC) within the context of IT-enabled innovation in a public sector context and to highlight the challenges facing organisations if they adopt a BR competence and capability framework.

Design/methodology/approach

The empirical research conducted within this paper is an exploratory survey. Exploratory surveys are particularly useful when investigating a little known phenomenon and can help to uncover or provide preliminary evidence of association among concepts. This survey was a census of all National Health Service acute hospital trusts in England.

Findings

The study indicates that most hospitals that participated in the survey have a basic approach to BR and have yet to develop a more mature approach that would provide the strong micro-foundations of a BR capability.

Research limitations/implications

The BR framework that has been the basis of the survey is interesting in terms of its components but is limited with regards to the micro-foundations of a benefits realisation capability within an organisation. The research suggests that organisations in the public sector need to focus much more on staff development and recruitment in the area of BR to ensure that they have the appropriate skills sets for a rapidly changing environment.

Originality/value

The paper proposes a framework for BR capabilities and IT-enabled change, and suggests that although the concept of maturity is valuable when considering the micro-foundations of BR, DCs change and respond to stimuli within the external and internal environment and must be renewed and refreshed regularly.

Improving a health information system for real-time data entries: An action research project using socio-technical systems theory

BACKGROUND/PURPOSE

This paper presents the findings of an action research (AR) project to improve a health information system (HIS) at the Operating Theater Department (OTD) of a National Health Service (NHS) hospital in South East England, the UK.

METHODS

Informed by socio-technical systems (STS) theory, AR was used to design an intervention to enhance an existing patient administration system (PAS) to enable data entries in real time while contributing to the literature. The study analyzed qualitative data collected through interviews, participant observations, and document reviews.

RESULTS

The study found that the design of the PAS was unsuitable to the work of the three units of the OTD. Based on the diagnoses and STS theory, the project developed and implemented a successful intervention to enhance the legacy system for data entries in real time.

CONCLUSIONS

The study demonstrates the value of AR from a socio-technical perspective for improving existing systems in healthcare settings. The steps adopted in this study could be applied to improve similar systems. A follow-up study will be essential to assess the sustainability of the improved system.

Implementing operations strategy through Lean processes within health care

Purpose

The purpose of this paper is to investigate how operations strategy and Lean concepts can be applied within a healthcare organisation and the degree to which both Lean and operations strategy are understood by senior-level National Health Service (NHS) personnel, based on the process of ongoing longitudinal cases studies. Further interviews and data analysis will examine actual performance of Lean capabilities within the NHS.

Design/methodology/approach

For this explanatory multiple-case study project the authors collected data through semi-structured interviews with executives in the NHS to understand how operations strategies are developed in the NHS and implemented in NHS hospitals. The unit of analysis is the hospital. Multiple (22) interviews took place over 12 months with senior-level personnel responsible for implementing change via operations strategy goals, and incorporating Lean initiatives. In addition, to triangulate data, the authors examined healthcare reports and strategy policy documents from each case hospital. This forms stage 1 of a longitudinal study which will examine the actual performance of Lean within the NHS hospitals across a range of operations parameters and explore links between such capabilities and the role and importance of operations strategy in more detail.

Findings

The findings lead to the conclusion that operations strategies were not fully developed within the hospitals. In addition, the ongoing data capture shows that “Best practice” was not being disseminated across the NHS, for either patient experience or organisational effectiveness and the role of operations strategy was not fully clear other than as a rather vague “umbrella” term. Despite Lean’s attraction for healthcare at a micro-level, significant operational and cultural hurdles must be overcome for the full strategic benefits of Lean to be realised. A much more holistic approach in providing a full service for the whole of the patient journey is needed.

Research limitations/implications

The sample provides an initial snapshot. A larger number of hospitals and/or further longitudinal research will be needed to deepen understanding of embedding strategic change to improve overall performance.

Practical implications

Tackling cultural performance and operational issues at a macro-level could help healthcare providers reconcile the perceived conflicting goals of improving patient care (i.e. service delivery) whilst simultaneously reducing costs. The role of explicit operations strategies could be pivotal in designing and implementing such change.

Originality/value

This research builds on and extends the work of Toussaint and Berry (2013), Seddon and O’Donovan (2010) and Carlborg and Kowalkowski (2013). The authors highlight how some of the apparent contradictions in the requirements of the various stakeholders create operational and strategic tensions. The authors highlight the multi-faceted nature of design and delivery of a multi-touchpoint service within the complexity of a large healthcare provider.