Lean implementation in healthcare supply chain: a scoping review

Effect of cyclic meditation on anxiety and sleep quality in sailors on merchant ships-A quasi-experimental study

Background

Sailors undergo anxiety and sleep disturbances due to prolonged journeys and the nature of their work on ships. Earlier studies indicate Cyclic Meditation (CM) being beneficial for managing anxiety and improving sleep quality. Thus, the current study was designed to investigate the effect of CM on anxiety and sleep quality among sailors.

Materials and methods

Fifty sailors were assigned to experimental (n = 25) and control (n = 25) groups. The experimental group received 45 min of CM, 7 days a week for 3 weeks. Control group continued with their routine activities and were offered CM practice the following 3 weeks. Hamilton Anxiety Scale for anxiety (HAM-A) and the Pittsburg Sleep Quality Index (PSQI) for sleep along with blood pressure and pulse rate were taken at baseline and by the end of 3 weeks. Data were analyzed using Repeated Measures Analysis of Variance (RM ANOVA) for within and between group effects.

Results

Significant differences were found between the groups following 3 weeks for all the variables. Experimental group demonstrated reduced anxiety (p < 0.001) and improved sleep (p < 0.001) along with improvements in blood pressure and pulse rate. The control group did not show any significant changes following 3 weeks.

Conclusion

CM could be incorporated as a routine for sailors to manage their anxiety and improve sleep quality during the period on board ships.

Diagnosing patient flow issues in the emergency department: an Australasian hospital case study

PURPOSE

This study investigates how a hospital can increase the flow of patients through its emergency department by using benchmarking and process improvement techniques borrowed from the manufacturing sector.

DESIGN/METHODOLOGY/APPROACH

An in-depth case study of an Australasian public hospital utilises rigorous, multi-method data collection procedures with systems thinking to benchmark an emergency department (ED) value stream and identify the performance inhibitors.

FINDINGS

High levels of value stream uncertainty result from inefficient processes and weak controls. Reduced patient flow arises from senior management's commitment to simplistic government targets, clinical staff that lack basic operations management skills, and fragmented information systems. High junior/senior staff ratios aggravate the lack of inter-functional integration and poor use of time and material resources, increasing the risk of a critical patient incident.

RESEARCH LIMITATIONS/IMPLICATIONS

This research is limited to a single case; hence, further research should assess value stream maturity and associated performance enablers and inhibitors in other emergency departments experiencing patient flow delays.

PRACTICAL IMPLICATIONS

This study illustrates how hospital managers can use systems thinking and a context-free performance benchmarking measure to identify needed interventions and transferable best practices for achieving seamless patient flow.

ORIGINALITY/VALUE

This study is the first to operationalise the theoretical concept of the seamless healthcare system to acute care as defined by Parnaby and Towill (2008). It is also the first to use the uncertainty circle model in an Australasian public healthcare setting to objectively benchmark an emergency department's value stream maturity.

Is It Still Time for Safety Walkaround? Pilot Project Proposing a New Model and a Review of the Methodology

Background and Objectives: Healthcare facilities are complex systems due to the interaction between different factors (human, environmental, management, and technological). As complexity increases, it is known that the possibility of error increases; therefore, it becomes essential to be able to analyze the processes that occur within these contexts to prevent their occurrence, which is the task of risk management. For this purpose, in this feasibility study, we chose to evaluate the application of a new safety walkaround (SWA) model. Materials and Methods: A multidisciplinary working group made up of experts was established and then the subsequent phases of the activity were divided into three stages, namely the initial meeting, the operational phase, and the final meeting, to investigate knowledge regarding patient safety before and subsequently through visits to the department: the correct compilation of the medical record, adherence to evidence-based medicine (EBM) practices, the overall health and the degree of burnout of the various healthcare professionals, as well as the perception of empathy of staff by patients. Results: This working group chose to start this pilot project in the vascular surgery ward, demonstrating the ability of the tool used to capture the different aspects it set out to collect. In detail, the new version of SWA proposed in this work has made it possible to identify risk situations and system vulnerabilities that have allowed the introduction of corrective tools; detect adherence to existing company procedures, reschedule training on these specific topics after reviewing, and possibly update the same procedures; record the patient experience about the doctor-patient relationship and communication to hypothesize thematic courses on the subject; evaluate workers' perception of their health conditions about work, and above all reassure operators that their well-being is in the interest of the management of the healthcare company, which is maintained. Conclusions: Therefore, the outcome of the present study demonstrates the versatility and ever-present usefulness of the SWA tool.

5S management improves the service quality in the outpatient-emergency pharmacy: from management process optimisation to staff capacity enhancement

OBJECTIVE

As a high-efficiency demanding department in a hospital, the outpatient pharmacy has a great need for quality improvement to provide superior medical service for patients. Little is known about the application of 5S management in a hospital pharmacy department. The aim of this study was to evaluate the impacts of 5S management on pharmaceutical service quality and staff capacity in the outpatient-emergency pharmacy.

METHODS

We carried out a 5S project in the outpatient-emergency pharmacy at a local hospital that involved processes including waste elimination, workplace standardisation, and optimisation of workflow and staff quality, and then evaluated the effects of the project.

RESULTS

The equipment and items in the outpatient-emergency pharmacy were sorted. All the drugs were categorised and put in order. The redesigned workspace and standardised workflow during the project improved the accuracy and efficiency of drug dispensing. The satisfaction rate of patients regarding the pharmaceutical service quality in the outpatient-emergency pharmacy was elevated, as well as the satisfaction rate of pharmacists about their work experiences. The optimisation of objective conditions also stimulated a positive working attitude and professional ability promotion of pharmacists in the outpatient-emergency pharmacy.

CONCLUSIONS

In this study, the 5S management method has proven useful for quality and efficiency improvement in the outpatient-emergency pharmacy, and could be generalised to other departments in a hospital, which provides further evidence of the advantages of the Lean tool in healthcare system management.

Leagility in the healthcare research: a systematic review

BACKGROUND

Expenditure of healthcare services has been growing over the past decades. Lean and agile are two popular paradigms that could potentially contain cost and improve proficiency of the healthcare system. However no systematic review was found on leagilty in the healthcare research. This study aims at synthesizing the extant literature of leagility in the healthcare area to consolidate its potential and identify research gaps for future study in the field.

METHODS

A systematic literature review is conducted following the PRISMA checklist approach. Studies were searched in multiple databases. The selection of articles was executed by dual-scanning of two researchers to ensure quality of data and relevance to the topic. Scientific articles published between January 1999 and November 2023 concerning leagile healthcare are analysed using Microsoft Excel and VOSviewer (version 1.6.18).

RESULTS

Out of 270 articles identified from the inclusion and exclusion criteria, 24 were included in the review. A total of 11 target areas were identified in leagility applications in healthcare. Success and limiting factors of leagile healthcare were classified into macro and micro aspects and further categorized into six dimensions: policy, organization, human resources, marketing, operation management and technology. Moreover, four research gaps were revealed and suggestions were provided for future study.

CONCLUSION

Leagility in the healthcare context is still being in its infancy. Few empirical validation was found in leagile healthcare literature. Further exploration into the application of theory in various sectors under the scope of healthcare is appealed for. Standardization and modularization, leadership support, skillfulness of professionals and staff training are the factors most frequently mentioned for a successful implementation of leagility in the healthcare sector.

Greening Hand Surgery: Targeted Measures to Reduce Waste in Ambulatory Trigger Finger and Carpal Tunnel Decompression

BACKGROUND

Operating rooms (ORs) produce approximately 70% of hospital waste. Greening strategies in the OR aim to reduce the environmental impact of surgery while maintaining patient safety and outcomes. The aim of this study was to strategically reduce waste and cost associated with common ambulatory hand procedures by implementing a 3-stage "green case" plan over a 1-year period in a high-volume tertiary referral hand surgery division.

METHODS

A 3-stage greening initiative for hand surgery was designed and implemented in ambulatory open carpal tunnel release (CTR) and trigger finger release (TFR) cases, including: (1) introduction of minor field sterility; (2) implementation of a lean and green minor hand surgery pack and reduced instrument set; and (3) elimination of gown use by surgeons and OR staff. Surgical supply usage and costs were tracked during the study period and compared with control.

RESULTS

Each "green case" resulted in savings of $105 compared with the control cases from the preceding year, excluding cost savings associated with reduced waste processing. There was a 64% and 75% reduction in waste and costs after greening, respectively. This equates to a minimum institutional annual savings of $51 000 when used for CTR and TFR. There was no observed increase in surgical site infections or complications after the introduction of greening.

CONCLUSION

Greening initiatives can be successfully implemented by surgeons to reduce waste and costs. With targeted greening of CTR and TFR procedures, we significantly reduced waste and decreased costs while maintaining patient safety and outcomes.

Drivers and Barriers to Implementing the Internet of Things in the Health Care Supply Chain: Mixed Methods Multicase Study

BACKGROUND

Over the past 2 years, the COVID-19 pandemic has placed enormous pressure on the health care industry. There has been an increase in demand and, at the same time, a shortage of supplies. This has shown that supply chain management in the health care industry cannot be taken for granted. Furthermore, the health care industry is also facing other major challenges, such as the current labor market shortage. In the literature, the Internet of Things (IoT) is highlighted as an effective tool to build a more resilient and efficient supply chain that can manage these challenges. Although using IoT in supply chain management has been extensively examined in other types of supply chains, its use in the health care supply chain has largely been overlooked. Given that the health care supply chain, compared to others, is more complex and is under growing pressure, a more in-depth understanding of the opportunities brought by IoT is necessary.

OBJECTIVE

This study aims to address this research gap by identifying and ranking the drivers of and barriers to implementing IoT in the health care supply chain.

METHODS

We conducted a 2-stage study. In the first, exploratory stage, a total of 12 semistructured interviews were conducted to identify drivers and barriers. In the second, confirmatory stage, a total of 26 health care supply chain professionals were asked in a survey to rank the drivers and barriers.

RESULTS

The results show that there are multiple financial, operational, strategy-related, and supply chain-related drivers for implementing IoT. Similarly, there are various financial, strategy-related, supply chain-related, technology-related, and user-related barriers. The findings also show that supply chain-related drivers (eg, increased transparency, traceability, and collaboration with suppliers) are the strongest drivers, while financial barriers (eg, high implementation costs and difficulties in building a business case) are the biggest barriers to overcome.

CONCLUSIONS

The findings of this study add to the limited literature regarding IoT in the health care supply chain by empirically identifying the most important drivers and barriers to IoT implementation. The ranking of drivers and barriers provides guidance for practitioners and health care provider leaders intending to implement IoT in the health care supply chain.

The Quality Management Improvement Approach: Successes and Lessons Learned From a Workforce Development Intervention in Rwanda's Health Supply Chain

BACKGROUND

Rwanda's supply chain is decentralized, with regional warehouse pharmacies and service delivery points (SDPs) ensuring a reliable health commodities supply. However, in 2016, the Rwanda Ministry of Health (MOH) identified challenges with the supply chain workforce contributing to a high stock-out rate, inventory stock inaccuracies, and underutilization of the electronic logistics management information system (e-LMIS). We aimed to document successes and lessons learned from implementing a workforce development intervention to address these challenges.

PROGRAM DESCRIPTION

Rwanda's MOH and the U.S. Agency for International Development Global Health Supply Chain Program-Procurement and Supply Management project implemented a workforce development intervention, the Quality Management Improvement Approach (QMIA), to improve and sustain Rwanda's service delivery and medicines availability. The QMIA monitors the performance of supply chain professionals while continuously building their capacity to run a smooth supply chain operation. The QMIA includes supervisory visits to measure key performance indicators and discussion sessions for experience-sharing and skill-building. The central level conducts both components, supporting regional warehouses that in turn assist SDPs through supervisory visits and discussion sessions.

RESULTS

Since 2017, the QMIA has been conducted twice a year in 596 SDPs and 30 regional warehouses and has trained 1,296 supply chain staff members. The intervention has contributed to major improvements in several key supply chain outcomes (2017 versus 2019): increased utilization of the e-LMIS (55% to 96%), higher inventory data accuracy (25% to 85%), and reduced stock-outs (10% to 1%).

CONCLUSIONS

The QMIA has proven to be a successful training and capacity-building platform for supply chain management in Rwanda, enhancing system utilization and availability of accurate data to guide decision-making. Notably, the approach fosters a positive behavioral change to build local solutions and improves communication.

Solutions for improved hospital-wide patient flows - a qualitative interview study of leading healthcare providers

BACKGROUND

Hospital productivity is of great importance for patients and public health to achieve better availability and health outcomes. Previous research demonstrates that improvements can be reached by directing more attention to the flow of patients. There is a significant body of literature on how to improve patient flows, but these research projects rarely encompass complete hospitals. Therefore, through interviews with senior managers at the world's leading hospitals, this study aims to identify effective solutions to enable swift patient flows across hospitals and develop a framework to guide improvements in hospital-wide patient flows.

METHODS

This study drew on qualitative data from interviews with 33 senior managers at 18 of the world's 25 leading hospitals, spread across nine countries. The interviews were conducted between June 2021 and November 2021 and transcribed verbatim. A thematic analysis followed, based on inductive reasoning to identify meaningful subjects and themes.

RESULTS

We have identified 50 solutions to efficient hospital-wide patient flows. They describe the importance for hospitals to align the organization; build a coordination and transfer structure; ensure physical capacity capabilities; develop standards, checklists, and routines; invest in digital and analytical tools; improve the management of operations; optimize capacity utilization and occupancy rates; and seek external solutions and policy changes. This study also presents a patient flow improvement framework to be used by healthcare managers, commissioners, and decision-makers when designing strategies to improve the delivery of healthcare services to meet the needs of patients.

CONCLUSIONS

Hospitals must invest in new capabilities and technologies, implement new working methods, and build a patient flow-focused culture. It is also important to strategically look at the patient's whole trajectory of care as one unified flow that must be aligned and integrated between and across all actors, internally and externally. Hospitals need to both proactively and reactively optimize their capacity use around the patient flow to provide care for as many patients as possible and to spread the burden evenly across the organization.

Professional Competence and Its Effect on the Implementation of Healthcare 4.0 Technologies: Scoping Review and Future Research Directions

BACKGROUND

The implementation of Healthcare 4.0 technologies faces a number of barriers that have been increasingly discussed in the literature. One of the barriers presented is the lack of professionals trained in the required competencies. Such competencies can be technical, methodological, social, and personal, contributing to healthcare professionals managing and adapting to technological changes. This study aims to analyse the previous research related to the competence requirements when adopting Healthcare 4.0 technologies.

METHODS

To achieve our goal, we followed the standard procedure for scoping reviews. We performed a search in the most important databases and retrieved 4976 (2011-present) publications from all the databases. After removing duplicates and performing further screening processes, we ended up with 121 articles, from which 51 were selected following an in-depth analysis to compose the final publication portfolio.

RESULTS

Our results show that the competence requirements for adopting Healthcare 4.0 are widely discussed in non-clinical implementations of Industry 4.0 (I4.0) applications. Based on the citation frequency and overall relevance score, the competence requirement for adopting applications of the Internet of Things (IoT) along with technical competence is a prominent contributor to the literature.

CONCLUSIONS

Healthcare organisations are in a technological transition stage and widely incorporate various technologies. Organisations seem to prioritise technologies for 'sensing' and 'communication' applications. The requirements for competence to handle the technologies used for 'processing' and 'actuation' are not prevalent in the literature portfolio.

Beyond efficiency: the role of lean practices and cultures in developing dynamic capabilities microfoundations

Purpose

The purpose of this study is to theorize and test the relationships among lean operations and lean supply chain practices, learning- and innovation-oriented lean cultures and dynamic capabilities (DCs) microfoundations. Further, this study aims to assess the association of DCs microfoundations with process innovation.

Design/methodology/approach

The researchers combine primary data collected from 153 manufacturing firms located in five continents using a survey designed for the purpose of this study with archival data downloaded from the Bureau Van Dijk Orbis database and test the hypothesized relationships using structural equation modelling.

Findings

Results support the contribution of lean operations and lean supply chain practices to the development of DCs microfoundations, which further lead to greater process innovation. Additionally, while a learning-oriented lean culture positively moderates the relationships between both lean operations and lean supply chain practices and DCs microfoundations, an innovation-oriented lean culture only moderates the relationship between lean operations practices and DCs microfoundations.

Practical implications

This study identifies DCs microfoundations as the key mechanisms for firms implementing lean practices to achieve greater levels of process innovation and the important role played by lean cultures. This study provides direction for managers to put in place DCs through lean implementations, enabling their firms to be ready to respond to challenges and opportunities generated by environmental changes.

Originality/value

While previous research has confirmed the positive effects of lean practices on efficiency, the role of lean practices and cultures in developing capabilities for reacting to environmental dynamism has received little attention. This study offers an empirically supported framework that highlights the potential of lean to adapt processes in response to environmental dynamics, thereby extending the lean paradigm beyond the traditional focus on operational efficiency.

Resilience development and digitalization of the healthcare supply chain: an exploratory study in emerging economies

Purpose

Healthcare supply chains (HSCs) have been adopting Industry 4.0 (I4.0) as a means to boost their resilience. The first objective of this study is to identify the effect of contextual variables of HSCs on resilience development and I4.0 adoption. Second, the paper examines the pervasiveness of the relationship between resilience and I4.0 across different contextual characteristics.

Design/methodology/approach

179 organizations from the HSC in Brazil and India were surveyed. Responses were analyzed using multivariate data techniques.

Findings

Large HSC agents are more likely to develop resilience abilities and adopt I4.0 technologies when these factors are analyzed independently. However, the joint analysis of resilience and I4.0 displayed a large number of significant correlations among small organizations.

Originality/value

Findings provide managers of HSC arguments to enhance resilience through the digitalization. HSC organizations can identify HSC organizations' context to tailor initiatives on resilience and digitalization.

Exploring changes in integration, differentiation, rules, coordination and performance following the introduction of a hospital planning centre: a case study

PURPOSE

This study explores how a hospital works, which is important for further enhancing hospital performance. Following the introduction of a Hospital Planning Centre (HPC), changes are explored in a hospital in terms of integration (the coordination and alignment of tasks), differentiation (the extent to which tasks are segmented into subsystems), rules, coordination mechanisms and hospital performance.

DESIGN/METHODOLOGY/APPROACH

A case study was conducted examining the hospital's social network, rules, coordination mechanisms and performance both before and after the introduction of the HPC. All planning and execution tasks for surgery patients were studied using a naturalistic inquiry and mixed-method approach.

FINDINGS

After the introduction of the HPC, the overall network structure and coordination mechanisms and coordination mechanisms remained largely the same. Integration and certain rules changed for specific planning tasks. Differentiation based on medical discipline remained. The number of local rules decreased and hospital-wide rules increased, and these remained largely in people's minds. Coordination mechanisms remained largely unchanged, primarily involving mutual adjustment and standardization of work both before and after the introduction of the HPC. Overall, the hospital's performance did not change substantially. The findings suggest that integration seems to "emerge" instead of being designed. Hospitals could benefit, we argue, from a more conscious system-wide approach that includes collective learning and information sharing.

ORIGINALITY/VALUE

This exploratory study provides in-depth insight into how a hospital works, yielding important knowledge for further research and the enhancement of hospital performance.

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.

Large scale healthcare facility redevelopment: A scoping review

Internationally, organisations are undertaking large scale facility redevelopment as a strategy for the transformation of care systems. Redeveloping facilities provides a once in a generation opportunity to transform health service delivery, typically, however, system level changes are poorly understood. To address this gap, our aim was to investigate the empirical knowledge base regarding large scale redevelopment of healthcare facilities. A scoping review was undertaken, guided by the redeveloped health service management (HSM) scoping review framework (HSM-SRF). Across 17 articles, five key concepts were identified, and they form the principles for successful redevelopment. First, establish a strong governance framework integrating diverse expertise and evidence base. Second, engage with internal and external stakeholders to build effectual relationships. Third, consult with end users, including clinicians and patients, to encourage the acceptance of the redevelopment and actively manage stakeholder dynamics, including politics and power undercurrents. Fourth, commit appropriate resources, including time, workforce, technology and finance to ensure redevelopment success. Finally, reimagine workflows through consultation with end users, including staff and consumers, allowing them to conceptualise how the space will be utilised. This scoping review is the first to synthesise the empirical knowledge base of the redevelopment of healthcare facilities.

Factors influencing procurement behaviour and decision-making: an exploratory qualitative study in a UK healthcare provider

Background

In 2016 the UK Department of Health and Social Care published the results of a comprehensive review of efficiency in hospitals, identifying “unwarranted variation” in procurement (or purchasing) practices for materials, supplies and devices. Addressing this variation in materials and supplies procurement practice has been identified as particularly important for creating efficiencies in health service delivery. However, little is known about the behaviour and experiences of front-line individuals who make these procurement decisions, which has implications for the development of strategies to improve efficiency. The objective of this study is to improve understanding of the factors influencing procurement behaviour and decisions among requisitioners who use an internal electronic procurement portal for medical supplies and equipment, and identify areas where efficiency could be improved.

Methods

Qualitative semi-structured individual interview study, following approximately 70 h of exploratory observations on site. The study context was a large London National Health Service (NHS) healthcare provider (the Trust), where we focussed primarily on purchases managed by a large hospital. Participants were drawn from requisitioners from multiple directorates across the Trust (n = 15; of these n = 2 clinical staff members, n = 13 non-clinical).

Results

Four factors stood out in our analysis as directly affecting procurement decisions: (1) a high level of variation in electronic purchasing and inventory management procedures throughout the Trust, (ii) an inaccurate and cumbersome search facility on the internal electronic procurement platform, exacerbated by poor IT skills training and support (iii) an inefficient purchase approvals system and (iv) multiple working sites and cluttered environments. We observed that these factors led requisitioners to employ a variety of strategies or so-called ‘workarounds’ to overcome the challenges they encountered, including stockpiling, relying on internal and supplier relationships, by-passing procedures to save time, purchasing outside existing agreements to save cost, and (re) delegating purchasing responsibilities among requisitioner staff - which both addressed and created difficulties.

Conclusions

Working with the assumption that staff ‘workarounds’ indicate where main issues lie, we offer four possible explanations to why they occur: (a) to maintain services and prepare for future care requirements, (b) to save on costs for the organisation, (c) to develop skills and development in purchasing and (d) to break silos and work collaboratively. These four explanations help provide initial starting points for improving efficiencies in health supplies’ procurement processes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-07065-0.

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.

Implementing a material planning and control method for special nutrition in a Brazilian public hospital

This study aims to (i) propose a demand forecast model for special nutrition materials in the context of health services, and (ii) comparatively evaluate three inventory management and control systems (periodic review, continuous review and mixed) for special nutrition materials. For that, we carried out a case study in a Brazilian public teaching hospital where data and information collection were conducted over a span of 22 months (from January 2018 and were consolidated until October 2019). A six-step approach was followed to propose the demand forecasting models and, later, evaluate the inventory control systems for special nutrition materials. Results indicate that if the organization implements the proposed inventory management method, there could be savings of up to 33% in the stock values managed by the healthcare organization. This research shows the planning and control of special nutrition materials in an integrated manner. Demand forecasting methods have been combined with inventory management to promote systemic improvements to healthcare organization.

Hospital Investment Decisions in Healthcare 4.0 Technologies: Scoping Review and Framework for Exploring Challenges, Trends, and Research Directions

BACKGROUND

Alternative approaches to analyzing and evaluating health care investments in state-of-the-art technologies are being increasingly discussed in the literature, especially with the advent of Healthcare 4.0 (H4.0) technologies or eHealth. Such investments generally involve computer hardware and software that deal with the storage, retrieval, sharing, and use of health care information, data, and knowledge for communication and decision-making. Besides, the use of these technologies significantly increases when addressed in bundles. However, a structured and holistic approach to analyzing investments in H4.0 technologies is not available in the literature.

OBJECTIVE

This study aims to analyze previous research related to the evaluation of H4.0 technologies in hospitals and characterize the most common investment approaches used. We propose a framework that organizes the research associated with hospitals' H4.0 technology investment decisions and suggest five main research directions on the topic.

METHODS

To achieve our goal, we followed the standard procedure for scoping reviews. We performed a search in the Crossref, PubMed, Scopus, and Web of Science databases with the keywords investment, health, industry 4.0, investment, health technology assessment, healthcare 4.0, and smart in the title, abstract, and keywords of research papers. We retrieved 5701 publications from all the databases. After removing papers published before 2011 as well as duplicates and performing further screening, we were left with 244 articles, from which 33 were selected after in-depth analysis to compose the final publication portfolio.

RESULTS

Our findings show the multidisciplinary nature of the research related to evaluating hospital investments in H4.0 technologies. We found that the most common investment approaches focused on cost analysis, single technology, and single decision-maker involvement, which dominate bundle analysis, H4.0 technology value considerations, and multiple decision-maker involvement.

CONCLUSIONS

Some of our findings were unexpected, given the interrelated nature of H4.0 technologies and their multidimensional impact. Owing to the absence of a more holistic approach to H4.0 technology investment decisions, we identified five promising research directions for the topic: development of economic valuation methodologies tailored for H4.0 technologies; accounting for technology interrelations in the form of bundles; accounting for uncertainties in the process of evaluating such technologies; integration of administrative, medical, and patient perspectives into the evaluation process; and balancing and handling complexity in the decision-making process.

Contributions of Industry 4.0 to supply chain resilience

Purpose

This study aims at identifying the contribution of Industry 4.0 (I4.0) integration into supply chains (SCs) to the enhancement of SC resilience.

Design/methodology/approach

A scoping review was conducted so that the relevant literature on SC resilience, and I4.0 integrated into SC management was examined.

Findings

The authors summarize the main findings from existing research and propose three research directions: (1) empirical validation of the contribution of I4.0 ICTs to SC resilience; (2) explore the role of processing-actuation technologies in enhancing restorative capacity; and (3) integration between I4.0 ICTs and omni-channel strategy as a means to resilience development at consumer and retail levels. The literature on the design of resilient smart SCs is far outnumbered by works reporting applications of I4.0 ICTs at different SC tier levels. However, the authors’ scoping review organizes the information available on these themes, setting the ground for the development of new theoretical propositions.

Originality/value

The integration of digital technologies from I4.0 can fundamentally change the SC management, acting as enablers of a more effective response to disruptions. However, the digital transformation of SCs is still incipient, and literature is particularly sparse when considering the contribution of I4.0 to the resilience of SCs.

Kanban system applications in healthcare services: A literature review

Lean Management method has been applied in several fields before its implementation in healthcare area. Among the different techniques associated with Lean, in this paper, we are focused on Kanban system, which is a method that presents several benefits such as inventory holding reduction or improvement of the employees' satisfaction. Our main objective is to carry out a literature review focused on Kanban methodology applied to health care. In this sense, this study can serve as a script to improve hospital management in pandemic periods, such as the one currently lived on COVID-19. We carry out a literature review searching in four different databases. We combine several terms to achieve our objective. We identify several articles which describe Kanban methodology applied to health field. More specifically, we present in what areas (nursing or pharmacy, among others) this method has been applied. In addition, we show all the barriers as well as benefits caused by the implementation of this system. There are a few studies focused on analysing how Kanban is applied to health care. Therefore, we can affirm that this topic is still recent.

Development of supply chain value stream map for government-supported drug distribution system

Purpose

The requirement of high-quality government-supported healthcare services has necessitated the significance of recognizing new management practices to enhance patient satisfaction. Hence, the purpose of this study is to address the patient's enhanced custom needs through the implementation of supply chain value stream mapping (SCVSM) in government-supported drug distribution system (DDS) for enhanced patient's satisfaction.

Design/methodology/approach

This study elucidates the role of one popular emerging management technique (i.e. SCVSM) in the healthcare sector by an investigative case study. The DDS in Rajasthan (India) was selected for this study. The data for this analysis were gathered in three ways (i.e. direct observation, documentary analysis and semi-structured interviews).

Findings

The outcome of this current study reveals that it is possible to apply the tool (SCVSM) to investigate the wastes in DDS to deliver the medicines at right time, right quantity and right quality. The application of SCVSM concluded that the various Kaizens (areas needed to improve) in lead time; transportation and routing should be adopted. The study further implemented kaizen on the current SCVSM and developed future SCVSM.

Research limitations/implications

Although various stages and functions exist in the healthcare supply chain, the current study is focused on the distribution system of drugs. The proposed approach provides a platform for both researchers and academicians to understand the existing DDS and to implement the SCVSM approach in the healthcare environment. The results show that the proposed SCVSM model is able to identify some operational bottlenecks and wastes which interfere in DDS.

Originality/value

It was observed that limited literature related to lean implementation on DDS and implementation of SCVSM on the healthcare environment in general and government-supported or public in specific are available. The current study on the application of SCVSM in DDS is unique in nature and will definitely add value to the existing literature of the application of value stream mapping (VSM) on the healthcare supply chain management field.

Opportunities and challenges for contactless healthcare services in the post-COVID-19 Era

This study examines the opportunities and challenges involved with contactless healthcare services in the post-COVID-19 pandemic era. First, we reviewed the literature to analyze contactless or contact-free healthcare services that have been utilized in pre-and during the COVID-19 pandemic periods. Then, we interviewed medical experts and hospital administrators to gain knowledge about how healthcare providers are currently working to mitigate the spread of COVID and preparing for the post-pandemic period. Thus, we analyzed the evolution and utilization of contactless services during the three different time periods: pre-, during-, and post-COVID-19. The results indicated that in the post-COVID-19 era, a new normal of hybrid healthcare services would emerge. While some of the contactless services that have been practiced during the pandemic may revert to the traditional face-to-face services, those innovative contactless healthcare services that have been proven effective during the pandemic would be practiced or even advanced in the post-pandemic period due to the accelerating technological developments. This study suggests many potential opportunities and daunting challenges for healthcare institutions, policymakers, and consumers regarding the implementation of contactless services in the post-COVID-19 era.

Challenges for asthma units in response to COVID-19: a qualitative group dynamics analysis

OBJECTIVE

To develop a set of recommendations for the management of severe asthma during COVID-19 pandemic.

METHODS

Eleven pneumologists and allergologists who were staff members of officially accredited asthma units in Catalonia (Spain) participated in a cross-section study based on three 2-hour virtual workshops (first: brainstorming, second: identification of impacts and challenges summarized in 10 topics, third: establishment of final recommendations by consensus).

RESULTS

Impacts and challenges identified were improvement of referral protocols between different levels of care; assessment of the minimum number of function tests to be performed and promote the performance of spirometry in primary care; implementation of videoconferencing, mobile apps, telephone calls, or integral virtual platforms for the follow-up of patients, and definition of the model of care (face-to-face, telematics, mixed) according to the patient's individual needs; self-administration of biologics for domiciliary treatment; and empowerment of the role of nursing and hospital pharmacy in particular for follow-up and self-administration of biologics. The main recommendations included coordination between primary care and specialized care consultation, optimization of lung function testing, implementation of telemedicine, and the role of nursing and hospital pharmacy.

CONCLUSION

The specific proposals in response to the effect of COVID-19 pandemic focused on four areas of interest (coordination between primary care and specialized care, optimization of lung function testing, implementation of telemedicine, and empowerment of the role of nursing and hospital pharmacy) may be generalized to other health care settings, and help to introduce new ways of caring asthma patients in the COVID-19 context.

Application of Lean Six Sigma in conservative dentistry: an action research at an Indian dental college

Purpose

The article evaluates the obstacles, lessons learned and managerial implications of deploying Lean Six Sigma (LSS) in a dental college hospital in India.

Design/methodology/approach

The work adopts the action research (AR) methodology to establish a case study, which is carried out using the LSS define–measure–analyze–improve–control (DAMIC) approach in a dental college. It uses LSS tools to enhance the productivity and performance of the Conservative Dentistry Department of a dental college and to unravel the obstacles and success factors in applying it to the education and healthcare sector together.

Findings

The root cause for high turn-around time (TAT) is ascertained using LSS tools and techniques. The effective deployment of the solutions to the root causes of variation assists the dental college to reduce the TAT of the Conservative Dentistry process from an average of 63.9 min–36.5 min (i.e. 42.9% improvement), and the process Standard Deviation (SD) was reduced from 2.63 to 2 min. This, in turn, raises the sigma level from 0.48 to 3.23, a noteworthy successful story for this dental college.

Research limitations/implications

While the results and recommendations of this research are focused on a single case study, it is to be noted that the case study is carried out with new users of LSS tools and techniques, especially with the assistance of interns. This indicates the applicability of LSS in dental colleges; thus, the adopted modality can be further refined to fit India's education and hospital sector together.

Originality/value

This article explains the implementation of LSS from an aspiring user viewpoint to assist dental colleges and policymakers in improving competitiveness. In addition, the medical education sector can introduce an LSS course in the existing programme to leverage the potential of this methodology to bring synergy and collaborative research between data-based thinking and the medical field based on the findings of this study. The most important contribution of this article is the illustration of the design of experiments (DOE) in the dental college process.

Lessons from mandated implementation of a performance management system

PURPOSE

Lean-inspired approaches and performance management systems are being implemented in public healthcare organisations internationally. However, the literature is inconclusive regarding the benefits of these management tools and there is a lack of knowledge regarding processes for large-scale implementation of these tools. This article aims to describe the implementation process and to better understand how this process influences the mandated performance management system.

DESIGN/METHODOLOGY/APPROACH

This research is based on a comparative case study of three healthcare organisations in Canada. Data consist documents, non-participant observation and semi-structured interviews with key actors (n = 30). Analysis is based on a sociotechnical approach to management tools that considers organisational context, and the tool's technical substrate, theory of action and managerial philosophy.

FINDINGS

Results show that despite a standardised national mandate, the tool as implemented varied between organisations in terms of technical substrate and managerial philosophy. These variations are explained by the flexibility of the technical substrate, the lack of clarity of the managerial philosophy, and some contextual elements. Successful implementation may rest upon high hybridization of the tool on these different dimensions. A precise and prescribed technical substrate is not sufficient to guarantee implementation of a managerial philosophy.

PRACTICAL IMPLICATIONS

Mandated implementation of management tools may be more successful if it is explicit on the managerial philosophy, the technical substrate and the link between the two, and if it provides some leeway to adapt both to the organisational context.

ORIGINALITY/VALUE

This is one of the few studies to describe and analyse the process involved in mandated large-scale implementation of performance management systems in public healthcare organisations.

Explaining integration and differentiation by identifying the rules and coordination mechanisms in a hospital's logistical system

Purpose

Integration, that is, the coordination and alignment of tasks, is widely promoted as a means to improve hospital performance. A previous study examined integration and differentiation, that is, the extent to which tasks are segmented into subsystems, in a hospital's social network. The current study carries this research further, aiming to explain integration and differentiation by studying the rules and coordination mechanisms that agents in a hospital network use.

Design/methodology/approach

The current case study deepens the analysis of the social network in a hospital. All planning tasks and tasks for surgery performance were studied, using a naturalistic inquiry approach and a mixed method.

Findings

Of the 314 rules found, 85% predominantly exist in people's minds, 31% are in documents and 7% are in the information system. In the early planning stages for a surgery procedure, mutual adjustment based on hospital-wide rules is dominant. Closer to the day of surgery, local rules are used and open loops are closed through mutual adjustment, thus achieving integration. On the day of surgery, there is mainly standardization of work and output, based on hospital-wide rules. The authors propose topics for future research, focusing on increasing the hospital's robustness and stability.

Originality/value

This exploratory case study provides an overview of the rules and coordination mechanisms that are used for organizing hospital-wide logistics for surgery patients. The findings are important for future research on how integration and differentiation are effectively achieved in hospitals.

Lean management in health care: a review of reviews of socio-technical components for effective impact

PURPOSE

The aims of the implementation of lean management in health care are to improve quality of care, to eliminate waste and to increase efficiency. The purpose of this study is to contribute to the advancement of knowledge by investigating which main socio-technical factors are considered to be effective for the implementation and management of lean initiatives.

DESIGN/METHODOLOGY/APPROACH

A systematic review of literature reviews on lean management in health care was conducted. The components of the socio-technical system are identified by moving from the socio-technical drivers that support organization-wide quality improvement practices and the lean implementation process in health care. The impacts of lean management are classified using the internal processes, patient, learning and financial dimensions.

FINDINGS

The 28 reviews retrieved confirm the current and increasing interest in lean management. While more than 60% of them call for a system-wide approach, system-wide implementations have rarely been observed, and, instead, adoption in isolated units or departments, or the use of single techniques and tools, prevails. The most commonly investigated socio-technical components are organizational structure, techniques and tools and organizational culture and strategic management. Significant impacts are reported for all the four dimensions. Nonetheless, the review reveals that there is still a lack of evidence on the sustainability of lean results and a need for a standardized impact measurement system.

ORIGINALITY/VALUE

This work stands out as the first review of reviews of how the socio-technical components of the lean management approach obtain positive impacts within the patient, internal processes, learning and financial dimensions.

Identifying integration and differentiation in a Hospital's logistical system: a social network analysis of a case study

Background

Integration, the coordination and alignment of tasks, has been promoted widely in order to improve the performance of hospitals. Both organization theory and social network analysis offer perspectives on integration. This exploratory study research aims to understand how a hospital’s logistical system works, and in particular to what extent there is integration and differentiation. More specifically, it first describes how a hospital organizes logistical processes; second, it identifies the agents and the interactions for organizing logistical processes, and, third, it establishes the extent to which tasks are segmented into subsystems, which is referred to as differentiation, and whether these tasks are coordinated and aligned, thus achieving integration.

Methods

The study is based on case study research carried out in a hospital in the Netherlands. All logistical tasks that are executed for surgery patients were studied. Using a mixed method, data were collected from the Hospital Information System (HIS), documentation, observations and interviews. These data were used to perform a social network analysis and calculate the network metrics of the hospital network.

Results

This paper shows that 23 tasks are executed by 635 different agents who interact through 31,499 interaction links. The social network of the hospital demonstrates both integration and differentiation. The network appears to function differently from what is assumed in literature, as the network does not reflect the formal organizational structure of the hospital, and tasks are mainly executed across functional silos. Nurses and physicians perform integrative tasks and two agents who mainly coordinate the tasks in the network, have no hierarchical position towards other agents. The HIS does not seem to fulfill the interactional needs of agents.

Conclusions

This exploratory study reveals the network structure of a hospital. The cross-functional collaboration, the integration found, and position of managers, coordinators, nurses and doctors suggests a possible gap between organizational perspectives on hospitals and reality. This research sets a basis for further research that should focus on the relation between network structure and performance, on how integration is achieved and in what way organization theory concepts and social network analysis could be used in conjunction with one another.

Reliability of internal logistics distribution in a hospital

Purpose

The main objective of the research is to propose a method to assess the reliability of hospitals' internal logistics distribution.

Design/methodology/approach

A structured methodology was defined in five stages: (1) data collection and current state mapping; (2) future state design; (3) identification of the uncertainties and sources of variation; (4) reliability analysis of the proposed future state and (5) identification and prioritization of improvements.

Findings

Results show shortcomings of the future state design and propose solutions to obtain a state that is more realistic and possible to perform. Subsequently, the feasibility of these improvements was analysed in order to be implemented in a real context, searching and identifying different uncertainty sources occurring inside the system.

Originality/value

Studies that have addressed hospital's internal logistics are scarce. Such gap highlights the need for this research developments that address the reliability enhancement in hospitals internal logistics.

Leanness evaluation in health-care organizations using fuzzy logic approach

Purpose

Lean practices are one of the fundamental practices adopted by health-care organizations to improve service quality and to reduce cost. In this context, the measurement of leanness in health-care organizations has become imperative. The purpose of this study is to measure the leanness of a hospital using fuzzy logic.

Design/methodology/approach

The design of the research includes two major steps. First, the identification of enablers, criteria and attributes of leanness constitutes the measures of assessment. Second, the above measures in the case hospital are assessed by using fuzzy logic approach.

Findings

This study suggests that leanness assessment is essential to identify the current lean capability of a health-care organization. This would help the health-care organizations to improve their lean performance further. The findings of the study suggest that the leanness of the case hospital is “Lean” (fuzzy range: 5.61, 7.24 and 8.91).

Practical implications

This study brings in three important implications from managerial point of view. First, it helps the management to assess the current level of leanness of the hospital. Second, it identifies the attributes that prevent the organization from being more lean. Third, it provides suggestive measures to address the weaker attributes and enables the enhancement of lean performance further.

Originality/value

The leanness assessment framework developed in the hospital operations is found to be original, and it adds value to the leanness assessment in health-care operations.