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Liu S, Hu Y, Pfaff H, Feng X, Xie J, Zhang Z, Li D. Evaluating perceived value and expected value gaps based on patient experience during outpatient encounters: An empirical study in China. Heliyon 2024; 10:e37766. [PMID: 39323862 PMCID: PMC11421996 DOI: 10.1016/j.heliyon.2024.e37766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 09/07/2024] [Accepted: 09/09/2024] [Indexed: 09/27/2024] Open
Abstract
Background Improving the quality of care relies on understanding patients' perceptions and expectations based on their experiences. The study aimed to determine the gaps between patients' perceived value and expected value, and to identify critical areas for outpatient service improvement. Method This cross-sectional study was conducted in China from November 2020 to February 2021. A sample of 572 outpatients, randomly selected from a comprehensive tertiary public hospital, was surveyed using a validated patient perceived value questionnaire. Importance-performance analysis was used to evaluate the differences between patients' perceived and expected value. Results The scores of patients' expected value for outpatient services were significantly higher than their perceived value in all 29 items and 8 dimensions. The items with the highest and lowest gaps were "short waiting time" (-1.52) and "hospital reputation and popularity" (-0.24) respectively, and the dimensions of price and efficiency (functional value) were located in the quadrant of high expectation and low perception. Conclusion Our findings are useful for hospital administrators and policymakers to identify strategic focus areas and allocate resources rationally and effectively. We suggest healthcare providers should take measures to narrow the gaps, especially in terms of service efficiency and price.
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Affiliation(s)
- Sha Liu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Major Disciplinary Platform under Double First-Class Initiative for Liberal Arts at Huazhong University of Science and Technology (Research Center for High-Quality Development of Hospitals) , China
| | - Yinhuan Hu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Major Disciplinary Platform under Double First-Class Initiative for Liberal Arts at Huazhong University of Science and Technology (Research Center for High-Quality Development of Hospitals) , China
| | - Holger Pfaff
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences & Faculty of Medicine, University of Cologne, 50933 Koln, Germany
| | - Xiandong Feng
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Major Disciplinary Platform under Double First-Class Initiative for Liberal Arts at Huazhong University of Science and Technology (Research Center for High-Quality Development of Hospitals) , China
| | - Jinzhu Xie
- Hubei No. 3 People's Hospital, Wuhan, Hubei, China
| | - Zemiao Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Major Disciplinary Platform under Double First-Class Initiative for Liberal Arts at Huazhong University of Science and Technology (Research Center for High-Quality Development of Hospitals) , China
| | - Dehe Li
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Major Disciplinary Platform under Double First-Class Initiative for Liberal Arts at Huazhong University of Science and Technology (Research Center for High-Quality Development of Hospitals) , China
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Tanvir Anzum KM, Kibria MG. A conceptual model for evaluating readiness for lean practices using a fuzzy logic approach: A case study in Bangladeshi healthcare institutes. Heliyon 2024; 10:e36356. [PMID: 39281540 PMCID: PMC11395749 DOI: 10.1016/j.heliyon.2024.e36356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 07/28/2024] [Accepted: 08/14/2024] [Indexed: 09/18/2024] Open
Abstract
In the realm of healthcare, an imperative necessity for all, institutions are increasingly recognizing the advantages of adopting lean strategies to enhance performance. Lean implementation in healthcare can lead to significant improvements in efficiency, patient care, and overall institutional performance. This paper aims to assess the readiness levels for implementing lean practices in healthcare institutes in Bangladesh, employing a fuzzy logic approach. The construction of a conceptual model is grounded in literature review and expert opinions, incorporating critical enablers, criteria, and attributes identified from extensive research. Factors measured include leadership commitment, workforce capability, operational processes, technological infrastructure, and organizational culture, each pivotal in determining readiness for lean implementation. The fuzzy logic approach is particularly useful in this context due to its ability to handle uncertainty and imprecision, which are common in complex environments like healthcare. This methodology not only provides a clear picture of current capabilities but also highlights specific areas that need enhancement, paving the way for more targeted and effective lean interventions. Data sourced from consultations with experts in three prominent hospitals in Bangladesh forms the basis of the analysis, enabling a detailed examination of readiness levels. The model's application of fuzzy logic facilitates a comprehensive assessment, revealing 12 critical attributes across the hospitals that require attention. Interestingly, the evaluation identifies varying levels of readiness, with two hospitals demonstrating moderate readiness and one showing a lower level. This conceptual approach has significant potential to assist top management in healthcare companies by providing a structured framework to prioritize crucial areas for improvement. By accurately assessing readiness levels and pinpointing weaker aspects before implementing lean strategies, this study aims to transform the healthcare industry. Ultimately, its implementation has the potential to enhance organizational performance and elevate standards in patient care, contributing to improved healthcare delivery in Bangladesh and beyond.
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Affiliation(s)
- Kazi Md Tanvir Anzum
- Department of Industrial Engineering and Management, Khulna University of Engineering & Technology, Khulna, 9203, Bangladesh
| | - Md Golam Kibria
- Department of Industrial Engineering and Management, Khulna University of Engineering & Technology, Khulna, 9203, Bangladesh
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Kunnen YS, Roemeling OP, Smailhodzic E. What are barriers and facilitators in sustaining lean management in healthcare? A qualitative literature review. BMC Health Serv Res 2023; 23:958. [PMID: 37674182 PMCID: PMC10483794 DOI: 10.1186/s12913-023-09978-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 08/28/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Lean management (LM) is a continuous improvement methodology originating from manufacturing and is widely adopted in healthcare to improve processes. LM shows promising results in healthcare and research on the topic is increasing. However, it can be difficult to sustain LM over time, and an overview of facilitators or barriers that influence the sustainment of LM in a healthcare context is unavailable. METHODS Prior to search, five inclusion and exclusion criteria were defined to establish suitability of identified articles for our research question. This study was based on 24 selected peer-reviewed studies that reported on the sustainment of LM in healthcare organisations, published in the last five years. Following the Preferred Reporting Items for Systemtic Reviews and Meta-Analyses (PRISMA) guidelines, all articles were scanned, retrieved for full-text and analysed thematically. RESULTS Following thematic analysis, we identified four overarching themes: Mobilising Employees, Guiding Change Efforts, Methods, and Local Context. Key facilitators for supporting LM are fostering an improvement culture and learning culture, providing professional development opportunities, assigning more responsibilities to employees in decision making processes and appointing change agents to act as local LM leaders. Key barriers for sustaining LM include overburdening employees with responsibilities, omitting staff involvement during LM implementation, lack of patient engagement, lack of resources to engage with LM, a lack of leadership commitment and follow-up on projects, and a lack of knowledge of LM among leaders. CONCLUSION Overall, studies emphasise the importance of actively involving and engaging the workforce to embed LM into organisational culture. Reflecting on the origins of LM, healthcare organisations can find inspiration in the virtue of respecting people in their journey to sustain and cultivate an improvement culture. LM provides potential to change healthcare for the better and could help healthcare organisations to cope with increasing external pressures.
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Affiliation(s)
- Y S Kunnen
- Faculty of Economics and Business, University of Groningen, Groningen, the Netherlands
- Department of Innovation Management and Strategy, University of Groningen, Nettelbosje 2, Groningen, 9700 AV, the Netherlands
| | - O P Roemeling
- Department of Innovation Management and Strategy, University of Groningen, Nettelbosje 2, Groningen, 9700 AV, the Netherlands.
| | - E Smailhodzic
- Department of Innovation Management and Strategy, University of Groningen, Nettelbosje 2, Groningen, 9700 AV, the Netherlands
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Gray CP, Azevedo KJ, Urech TH, Lerner B, Charns MP, Vashi AA. Engaging Patients in the Veterans Health Administration's Lean Enterprise Transformation: A Qualitative Study. Qual Manag Health Care 2023; 32:75-80. [PMID: 35793546 DOI: 10.1097/qmh.0000000000000371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND OBJECTIVES Lean management is a strategy for improving health care experiences of patients. While best practices for engaging patients in quality improvement have solidified in recent years, few reports specifically address patient engagement in Lean activities. This study examines the benefits and challenges of incorporating patient engagement strategies into the Veterans Health Administration's (VA) Lean transformation. METHODS We conducted a multisite, mixed-methods evaluation of Lean deployment at 10 VA medical facilities, including 227 semistructured interviews with stakeholders, including patients. RESULTS Interviewees noted that a patient-engaged Lean approach is mutually beneficial to patients and health care employees. Benefits included understanding the veteran's point of view, uncovering inefficient aspects of care processes, improved employee participation in Lean events, increased transparency, and improved reputation for the organization. Challenges included a need for focused time and resources to optimize veteran participation, difficulty recruiting a diverse group of veteran stakeholders, and a lack of specific instructions to encourage meaningful participation of veterans. CONCLUSIONS/IMPLICATIONS As the first study to focus on patient engagement in Lean transformation efforts at the VA, this study highlights ways to effectively partner with patients in Lean-based improvement efforts. Lessons learned may also help optimize patient input into quality improvement more generally.
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Affiliation(s)
- Caroline P Gray
- Center for Innovation to Implementation (Ci2i) (Drs Gray, Azevedo, and Vashi and Ms Urech) and National Center for PTSD (NCPTSD) (Dr Azevedo), VA Palo Alto Health Care System, Palo Alto, California; Center for Healthcare Organization and Implementation Research, VA Boston Health Care System, Boston, Massachusetts (Drs Lerner and Charns); and Boston University School of Public Health, Boston, Massachusetts (Dr Charns)
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Fenner S, Netland T. Lean service: a contingency perspective. OPERATIONS MANAGEMENT RESEARCH 2023. [DOI: 10.1007/s12063-023-00350-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AbstractMany firms launch consolidated lean initiatives across all their service units, but because services differ, mandated lean practices may have a poor fit with the receiving unit. Whereas plenty of research has investigated the fit of lean implementation at the service industry level, this is the first to delineate how standard lean service practices fit different service types. Taking a contingency theory perspective, we study a leading European utility company comprising distinct service types. Using purposeful sampling, we interview 36 employees from 15 different teams representing three different service types – professional services, service factories and service shops – and 11 employees from the headquarters who are supporting these units in their lean transformation journeys. We also collect secondary data, including lean programme documentation and audit data. We find that one size does not fit all for lean service; there are important nuances to the relevance of standard lean service practices across different service types. Ten propositions are put forward suggesting how standard lean practices need to be adapted to fit the context of different service types. The findings reject the idea that all service units can progress along the same trajectory in lean service programmes. This paper informs managers how lean service programmes can be tailored to increase the fit with different service types.
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Bacelar-Silva GM, Cox JF, Rodrigues P. Achieving rapid and significant results in healthcare services by using the theory of constraints. Health Syst (Basingstoke) 2022; 13:48-61. [PMID: 38370321 PMCID: PMC10868449 DOI: 10.1080/20476965.2022.2115408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/12/2022] [Indexed: 10/15/2022] Open
Abstract
Lack of timeliness and capacity are seen as fundamental problems that jeopardise healthcare delivery systems everywhere. Many believe the shortage of medical providers is causing this timeliness problem. This action research presents how one doctor implemented the theory of constraints (TOC) to improve the throughput (quantity of patients treated) of his ophthalmology imaging practice by 64% in a few weeks with little to no expense. The five focusing steps (5FS) guided the TOC implementation - which included the drum-buffer-rope scheduling and buffer management - and occurred in a matter of days. The implementation provided significant bottom-line results almost immediately. This article explains each step of the 5FS in general terms followed by specific applications to healthcare services, as well as the detailed use in this action research. Although TOC successfully addressed the practice problems, this implementation was not sustained after the TOC champion left the organisation. However, this drawback provided valuable knowledge. The article provides insightful knowledge to help readers implement TOC in their environments to provide immediate and significant results at little to no expense.
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Affiliation(s)
- Gustavo M. Bacelar-Silva
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine (MEDCIDS-FMUP), University of Porto, Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
- Department of Distance Learning, Bahiana School of Medicine and Public Health, Salvador, Brazil
| | - James F. Cox
- Management Department, Terry College of Business,University of Georgia, Athens, Georgia, USA
| | - Pedro Rodrigues
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine (MEDCIDS-FMUP), University of Porto, Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
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Effects of Lean Interventions Supported by Digital Technologies on Healthcare Services: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159018. [PMID: 35897392 PMCID: PMC9330917 DOI: 10.3390/ijerph19159018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 12/31/2022]
Abstract
Despite the increasing utilization of lean practices and digital technologies (DTs) related to Industry 4.0, the impact of such dual interventions on healthcare services remains unclear. This study aims to assess the effects of those interventions and provide a comprehensive understanding of their dynamics in healthcare settings. The methodology comprised a systematic review following the PRISMA guidelines, searching for lean interventions supported by DTs. Previous studies reporting outcomes related to patient health, patient flow, quality of care, and efficiency were included. Results show that most of the improvement interventions relied on lean methodology followed by lean combined with Six Sigma. The main supporting technologies were simulation and automation, while emergency departments and laboratories were the main settings. Most interventions focus on patient flow outcomes, reporting positive effects on outcomes related to access to service and utilization of services, including reductions in turnaround time, length of stay, waiting time, and turnover time. Notably, we found scarce outcomes regarding patient health, staff wellbeing, resource use, and savings. This paper, the first to investigate the dual intervention of DTs with lean or lean–Six Sigma in healthcare, summarizes the technical and organizational challenges associated with similar interventions, encourages further research, and promotes practical applications.
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8
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London AE, Blackmore CC, Tufano AE, Quisenberry EJ, Plsek P. Coupling Lean and Experience-Based Design for Measuring and Incorporating Patient Emotional Experience Into the Redesign of Health Care. Qual Manag Health Care 2022; 31:184-190. [PMID: 34813582 DOI: 10.1097/qmh.0000000000000331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Incorporation of Lean into health care requires consideration of the patient and other customer experience of care as well as final health outcomes. We incorporate experience-based design (EBD) into our Lean management method to assess the experience of care, guide redesign of care processes, and assess the effectiveness of quality improvement on the care experience. Foundational to EBD is identification of "touch points," moments in the health care delivery process where a patient has a strong positive or negative emotional response that has the potential to alter the way patients feel about their overall care experience. METHODS EBD proceeds sequentially from qualitative assessment of customer experience and touch points (through observations and interviews); semiquantitatively assessing the experience across many patients (through EBD questionnaires); engaging in codesign with patients (through improvement teams and events); and reassessing the care experience after improvement (through follow-up EBD questionnaires). The use of project-specific (EBD) emotion word questionnaires enables assessment of change over time. These EBD questionnaires are developed ad hoc for each care improvement effort, to reflect the specific high emotion touch points patients identify for that care process, and therefore pose unique validity and reliability challenges. We have previously validated a set of emotion words that form the library from which questionnaire designers select the relevant emotion word choices. In addition, to assess consistency of measurement in the absence of any improvement, we performed a repeated-measures study deploying the same EBD questionnaire to different groups of patients, separated by a 60-day interval in the absence of any quality improvement work. RESULTS We apply EBD across the health care enterprise, including patients and family caregivers, as well as staff members. Examples where EBD has been incorporated into care redesign have included; outpatient care for pancreatic cancer patients; clinic visits in rheumatology; delirium care for hospital inpatients; and the orientation process for newly hired advanced practice providers. Our reliability data demonstrate that moderate differences in scores on the EBD questionnaire (up to 19 percentage points) may reflect random variability, but differences of greater magnitude reflect actual changes in the patient experience. CONCLUSIONS In summary, experience-based design has promise as a methodology to incorporate patient experience within a Lean management structure. EBD can aid with health care redesign, defining the emotional touch points that are foundational to the experience of care, enabling targeting of quality improvement efforts, and assessing change.
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Affiliation(s)
- Amy E London
- Virginia Mason Medical Center, Seattle, Washington
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Implementing Lean Techniques to Increase the Efficiency of a Rural Primary Care Clinic: A Prospective Controlled Study. Jt Comm J Qual Patient Saf 2022; 48:262-270. [DOI: 10.1016/j.jcjq.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 01/26/2022] [Accepted: 01/26/2022] [Indexed: 11/24/2022]
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Moffatt S, Garry C, McCann H, Teeling SP, Ward M, McNamara M. The Use of Lean Six Sigma Methodology in the Reduction of Patient Length of Stay Following Anterior Cruciate Ligament Reconstruction Surgery. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1588. [PMID: 35162610 PMCID: PMC8835068 DOI: 10.3390/ijerph19031588] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 02/04/2023]
Abstract
Background: The purpose of this study was to reduce the length of stay of anterior cruciate ligament reconstruction patients within a private hospital in Ireland, reducing any non-value-added activity in the patient pathway, with the goal of increasing patient flow, bed capacity, and revenue generation within the hospital system, while maintaining patient satisfaction. Methods: We used a pre-/post-intervention design and Lean Six Sigma methods and tools to assess and improve the current process. Results: A reduction in inpatient length of stay by 57%, and a reduction in identified non-value-added activity by 88%, resulted in a new day-case surgery pathway for anterior cruciate ligament reconstruction patients. The pathway evidenced no re-admissions and demonstrated patient satisfaction. Conclusion: Six months post-project commencement, we had successfully achieved our goals of reducing our anterior cruciate ligament reconstruction patient's length of stay. This study contributes to the growing body of published evidence which shows that adopting a Lean Six Sigma approach can be successfully employed to optimise care and surgical pathways in healthcare.
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Affiliation(s)
- Sinead Moffatt
- Beacon Hospital, Beacon Court, Bracken Rd, Sandyford Business Park, Sandyford, Dublin 18, D18 AK68 Dublin, Ireland; (C.G.); (H.M.)
| | - Catherine Garry
- Beacon Hospital, Beacon Court, Bracken Rd, Sandyford Business Park, Sandyford, Dublin 18, D18 AK68 Dublin, Ireland; (C.G.); (H.M.)
| | - Hannah McCann
- Beacon Hospital, Beacon Court, Bracken Rd, Sandyford Business Park, Sandyford, Dublin 18, D18 AK68 Dublin, Ireland; (C.G.); (H.M.)
| | - Sean Paul Teeling
- UCD Centre for Interdisciplinary Research, Education & Innovation in Health Systems, School of Nursing, Midwifery & Health Systems UCD Health Sciences Centre, D04 V1W8 Dublin, Ireland; (S.P.T.); (M.M.)
- Centre for Person-Centred Practice Research Division of Nursing, School of Health Sciences, Queen Margaret University, Queen Margaret University Drive, Musselburgh EH21 6UU, UK
| | - Marie Ward
- Centre for Innovative Human Systems, School of Psychology, Trinity College, The University of Dublin, Dublin 2, D02 PN40 Dublin, Ireland;
| | - Martin McNamara
- UCD Centre for Interdisciplinary Research, Education & Innovation in Health Systems, School of Nursing, Midwifery & Health Systems UCD Health Sciences Centre, D04 V1W8 Dublin, Ireland; (S.P.T.); (M.M.)
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Tzadok B, Ben Tov O, Vaispapir V, Shornikov L, Marik O, Martens L, Tal Or E. Lean six sigma and stroke in rural hospital - The case of Baruch Padeh Medical Center. Int J Health Care Qual Assur 2022; ahead-of-print. [PMID: 35075887 DOI: 10.1108/ijhcqa-01-2021-0005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This case study aims to demonstrate the strengths of the Lean Six Sigma (LSS) methodology to improve the acute ischemic stroke (AIS) treatment rates and reduce process lead time at Baruch Padeh Medical Center (BPMC), a rural hospital in the Galilee region of Northern Israel. The LSS project redefined the BPMC stroke care pathway and increased its efficacy. DESIGN/METHODOLOGY/APPROACH The LSS methodology was implemented in September 2017 by integrating lean principles and the Six Sigma DMAIC (Define-Measure-Analyze-Improve-Control). Existing procedures, field observation, ad hoc measurement and in-depth interviews were utilized, and the GEMBA method was implemented to identify root cause and improve actions optimizing the stroke pathway. FINDINGS The presented case shows the usefulness of the LSS methodology in improving quality performance in a rural hospital. The intervention allowed the BPMC to improve the intravenous tissue plasminogen activator (IV-tPA) administration rate (+15.2%), reducing the process lead time. The lead time of door-to-computer tomography decreased from 52 to 26 min, and the door-to-needle time decreased from 94 to 75 min. ORIGINALITY/VALUE The present case study shows the implementation of the LSS methodology aimed to improve the IV-tPA administration rate and reduce the stroke pathway lead time in a rural hospital. The case demonstrates the potential for the LSS methodology to support the AIS pathway optimization and represents a guide for healthcare organizations located in rural areas.
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Affiliation(s)
| | | | | | | | | | - Leon Martens
- Integrated Health Solutions, Medtronic plc, Eindhoven, the Netherlands
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Zdęba-Mozoła A, Rybarczyk-Szwajkowska A, Czapla T, Marczak M, Kozłowski R. Implementation of Lean Management in a Multi-Specialist Hospital in Poland and the Analysis of Waste. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020800. [PMID: 35055621 PMCID: PMC8775623 DOI: 10.3390/ijerph19020800] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 11/18/2022]
Abstract
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.
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Affiliation(s)
- Agnieszka Zdęba-Mozoła
- Department of Management and Logistics in Healthcare, Medical University of Lodz, 6 Lindleya Street, 90-131 Lodz, Poland; (A.R.-S.); (M.M.)
- Correspondence:
| | - Anna Rybarczyk-Szwajkowska
- Department of Management and Logistics in Healthcare, Medical University of Lodz, 6 Lindleya Street, 90-131 Lodz, Poland; (A.R.-S.); (M.M.)
| | - Tomasz Czapla
- Department of Management, Faculty of Management, University of Lodz, 90-237 Lodz, Poland;
| | - Michał Marczak
- Department of Management and Logistics in Healthcare, Medical University of Lodz, 6 Lindleya Street, 90-131 Lodz, Poland; (A.R.-S.); (M.M.)
| | - Remigiusz Kozłowski
- Centre for Security Technologies in Logistics, Faculty of Management, University of Lodz, 90-237 Lodz, Poland;
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Hammoudeh S, Amireh A, Jaddoua S, Nazer L, Jazairy E, Al-Dewiri R. The Impact of Lean Management Implementation on Waiting Time and Satisfaction of Patients and Staff at an Outpatient Pharmacy of a Comprehensive Cancer Center in Jordan. Hosp Pharm 2021; 56:737-744. [PMID: 34732932 DOI: 10.1177/0018578720954147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Patient satisfaction with outpatient pharmacy services at our institution was below the target level, due mainly to long waiting times. A lean management strategy to reduce patient waiting time and increase the satisfaction of both patients and staff was developed and implemented. Methods: The project was conducted in the outpatient pharmacy of a comprehensive cancer center in Amman, Jordan. The process started with formation of a multidisciplinary team and A3 problem-solving, which is a 10-step scientific method with measurable patient-centered outcomes. Average patient waiting time and level of patient satisfaction were compared before and after full implementation of the process. In addition, a survey was conducted among the pharmacy staff who worked in the outpatient pharmacy during the process to determine its impact on staff satisfaction. Results: Patient waiting time for prescriptions of fewer than 3 medications and of 3 medications or more decreased significantly (22.3 minutes vs 8.1 minutes, P < .001, and 31.8 minutes vs 16.1 minutes, P < .002, respectively), and patient satisfaction increased (62% vs 69%; P = .005) after full implementation of the project. The majority of the pharmacy staff reported that the process motivated them in their work and that both their jobs and their relationships with their managers and colleagues had improved. Conclusion: Application of lean management in an outpatient pharmacy was effective in reducing patient waiting time and improving the satisfaction of both patients and employees.
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Affiliation(s)
| | | | | | - Lama Nazer
- King Hussein Cancer Center, Amman, Jordan
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14
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Santos ACDSGD, Reis ADC, Souza CGD, Santos ILD, Ferreira LAF. The first evidence about conceptual vs analytical lean healthcare research studies. J Health Organ Manag 2021; ahead-of-print. [PMID: 32945155 DOI: 10.1108/jhom-01-2020-0021] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Ana Carla de Souza Gomes Dos Santos
- Rio de Janeiro Federal Institute of Education Science and Technology Rio de Janeiro, Brazil.,Celso Suckow da Fonseca Federal Centre of Technological Education, Rio de Janeiro, Brazil
| | - Augusto da Cunha Reis
- Celso Suckow da Fonseca Federal Centre of Technological Education, Rio de Janeiro, Brazil
| | | | - Igor Leão Dos Santos
- Celso Suckow da Fonseca Federal Centre of Technological Education, Rio de Janeiro, Brazil
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De Freitas L, Goodacre S, O'Hara R, Thokala P, Hariharan S. A qualitative exploration of value and waste in a Trinidadian emergency department patient flow process: perspectives of patients and clinicians. J Health Organ Manag 2021; ahead-of-print. [PMID: 33619923 DOI: 10.1108/jhom-03-2020-0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE A process that does not include the customer's value may not be effective in providing care. This study aimed to identify value and waste in an emergency department (ED) patient flow process from a patient and clinician perspective. DESIGN/METHODOLOGY/APPROACH A qualitative case study was conducted in an ED in Trinidad and Tobago. Observations and informal conversational interviews with clinicians (n = 33) and patients (n = 50) explored patient flow, value and waste. Thematic analysis was used to create a framework on valuable and wasteful aspects in the ED patient flow process. FINDINGS Valuable aspects led to direct improvements in the patient's health or an exchange of information in the process. Wasteful aspects were those with no patient activity, no direct ED clinical involvement, or resulted in a perceived inappropriate use of ED resources. However, there was a disparity in responses between clinicians and patients with clinicians identifying more features in the process. RESEARCH LIMITATIONS/IMPLICATIONS The single case study design limits the generalizability of findings to other settings. This study did not specifically explore the influence of age and gender on what mattered to patients in ED services. Future studies would benefit from exploring whether there are any age and gender differences in patient perspectives of value and waste. Further research is needed to validate the usefulness of the framework in a wider range of settings and consider demographic factors such as age and gender. PRACTICAL IMPLICATIONS The study has produced a framework which may be used to improve patient flow in a way that maximized value to its users. A collaborative approach, with active patient involvement, is needed to develop a process that is valuable to all. The single case study design limits the generalizability of findings to other settings. ORIGINALITY/VALUE Qualitative methods were used to explicitly explore both value and waste in emergency department patient flow, incorporating the patient perspective. This paper provides an approach that decision makers may use to refine the ED patient flow process into one that flows well, improves quality and maximizes value to its users.
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Affiliation(s)
- Loren De Freitas
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Steve Goodacre
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Rachel O'Hara
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Praveen Thokala
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Seetharaman Hariharan
- The University of the West Indies Saint Augustine Campus, Saint Augustine, Trinidad And Tobago
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Reponen E, Rundall TG, Shortell SM, Blodgett JC, Juarez A, Jokela R, Mäkijärvi M, Torkki P. Benchmarking outcomes on multiple contextual levels in lean healthcare: a systematic review, development of a conceptual framework, and a research agenda. BMC Health Serv Res 2021; 21:161. [PMID: 33607988 PMCID: PMC7893761 DOI: 10.1186/s12913-021-06160-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/08/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Reliable benchmarking in Lean healthcare requires widely relevant and applicable domains for outcome metrics and careful attention to contextual levels. These levels have been poorly defined and no framework to facilitate performance benchmarking exists. METHODS We systematically searched the Pubmed, Scopus, and Web of Science databases to identify original articles reporting benchmarking on different contextual levels in Lean healthcare and critically appraised the articles. Scarcity and heterogeneity of articles prevented quantitative meta-analyses. We developed a new, widely applicable conceptual framework for benchmarking drawing on the principles of ten commonly used healthcare quality frameworks and four value statements, and suggest an agenda for future research on benchmarking in Lean healthcare. RESULTS We identified 22 articles on benchmarking in Lean healthcare on 4 contextual levels: intra-organizational (6 articles), regional (4), national (10), and international (2). We further categorized the articles by the domains in the proposed conceptual framework: patients (6), employed and affiliated staff (2), costs (2), and service provision (16). After critical appraisal, only one fifth of the articles were categorized as high quality. CONCLUSIONS When making evidence-informed decisions based on current scarce literature on benchmarking in healthcare, leaders and managers should carefully consider the influence of context. The proposed conceptual framework may facilitate performance benchmarking and spreading best practices in Lean healthcare. Future research on benchmarking in Lean healthcare should include international benchmarking, defining essential factors influencing Lean initiatives on different levels of context; patient-centered benchmarking; and system-level benchmarking with a balanced set of outcomes and quality measures.
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Affiliation(s)
- Elina Reponen
- Center for Lean Engagement and Research in Healthcare, School of Public Health, University of California, Berkeley, California, USA.
- HUS Helsinki University Hospital, P.O.Box 760, 00029, Helsinki, Finland.
| | - Thomas G Rundall
- Center for Lean Engagement and Research in Healthcare, School of Public Health, University of California, Berkeley, California, USA
| | - Stephen M Shortell
- Center for Lean Engagement and Research in Healthcare, School of Public Health, University of California, Berkeley, California, USA
| | - Janet C Blodgett
- Center for Lean Engagement and Research in Healthcare, School of Public Health, University of California, Berkeley, California, USA
| | - Angelica Juarez
- Center for Lean Engagement and Research in Healthcare, School of Public Health, University of California, Berkeley, California, USA
| | - Ritva Jokela
- HUS Helsinki University Hospital, P.O.Box 760, 00029, Helsinki, Finland
| | - Markku Mäkijärvi
- HUS Helsinki University Hospital, P.O.Box 760, 00029, Helsinki, Finland
| | - Paulus Torkki
- Department of Public Health, University of Helsinki, Helsinki, Finland
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Cox JF. Using the theory of constraints to create a paradigm shift in organisation performance at a large primary care provider practice. Health Syst (Basingstoke) 2021; 11:126-159. [DOI: 10.1080/20476965.2021.1876533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- James F. Cox
- Terry College of Business, Management Department, University of Georgia, Athens, United States
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Williams SJ, Radnor ZJ. Moving from service to sustainable services: a healthcare case study. INTERNATIONAL JOURNAL OF PRODUCTIVITY AND PERFORMANCE MANAGEMENT 2021. [DOI: 10.1108/ijppm-12-2019-0583] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PurposeWorldwide, healthcare systems struggle to sustain the delivery of services at a time of increasing demand, limited resources and growing expectations from users, coupled with dealing with the aftermath of the Covid-19 pandemic and the threat of other outbreaks. There has never been a more important time to sustain innovation and improvements. Using an illustrative case, the authors assess the application of two existing frameworks to identify the key propositions and dimensions required to deliver sustainable services.Design/methodology/approachThis illustrative case study focuses on a service provided by a chronic disease, multidisciplinary community healthcare team in the UK. Experienced-based interviews were conducted with health professionals, patients and relatives to provide a rich account of a care pathway design. A high-level process map is used to visualise the key touch points.FindingsThe authors identify all seven propositions of the SERVICE framework being present along with additional dimensions relating to sustaining innovation and improvement.Research limitations/implicationsThis research is limited to a chronic disease care pathway. However, the authors believe the results could be applicable to other medical conditions, which are supported by a similar multi-disciplinary service delivery model.Practical implicationsThe authors provide a sustainable public service operations SERVICES framework for health professionals and managers to consider when (re)designing care pathways.Originality/valueThis research contributes to the emerging discipline of public service operations research by empirically testing for the first time the SERVICE framework within healthcare. The authors have included additional factors associated with innovation and improvement and recommended further development of the framework to include factors, such as economic sustainability, highly relevant to the context of universal healthcare systems.
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Bacelar-Silva GM, Cox JF, Rodrigues PP. Outcomes of managing healthcare services using the Theory of Constraints: A systematic review. Health Syst (Basingstoke) 2020; 11:1-16. [PMID: 35127055 PMCID: PMC8812771 DOI: 10.1080/20476965.2020.1813056] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/16/2020] [Indexed: 10/23/2022] Open
Abstract
Despite ever-increasing resources devoted to healthcare, lack of capacity and timeliness are still chronic problems worldwide. This systematic review aims to present an overview of the Theory of Constraints (TOC) implementations in healthcare services and their outcomes. We analysed 42 TOC implementations (15 full-text articles, 12 video proceedings, and 2 theses/disserations) from major scientific electronic databases and TOC International Certification Organization Conferences. All implementations reported positive outcomes, both tangible and intangible. The two main improvements reported by authors were in productivity (98%; n = 41) - more patients treated - and in the timeliness of care (83%; n = 35). Furthermore, the selected studies reported dramatic improvements: 50% mean reductions in patient waiting time; 38% reduction in patient length of stay; 43% mean increase in operating room productivity and 34% mean increase in throughput. TOC implementations attained positive results in all levels of the health and social care chain. Most TOC recommendations and changes showed almost immediate results and required little or no additional cost to implement. Evidence supports TOC as a promising solution for the chronic healthcare problem, improving quality and timeliness, both necessary conditions for providing effective healthcare.
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Affiliation(s)
- Gustavo M Bacelar-Silva
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine (MEDCIDS-FMUP), University of Porto, Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
- Department of Distance Learning, Bahiana School of Medicine and Public Health, Salvador, Brazil
| | - James F Cox
- Management Department, Terry College of Business, University of Georgia, Athens, GA, USA
| | - Pedro Pereira Rodrigues
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine (MEDCIDS-FMUP), University of Porto, Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
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20
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Healthcare Engineering: A Lean Management Approach. JOURNAL OF HEALTHCARE ENGINEERING 2020; 2020:8875902. [PMID: 33082927 PMCID: PMC7556075 DOI: 10.1155/2020/8875902] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 06/05/2020] [Accepted: 09/21/2020] [Indexed: 12/01/2022]
Abstract
This work tries to answer the following question: can healthcare be engineered using lean management tools? Lean is known to achieve successful results when implemented in the manufacturing sector. Typical results are operational cost reduction, cycle time reduction, and higher customer satisfaction. The service sector, however, has seen mixed results. For the last two decades, educators and healthcare professionals are trying to implement lean tools in healthcare. Some reported success and many did not, for variety of reasons. In this paper, we search the literature and reveal the special nature of healthcare services, success factors, and barriers facing implementation of lean in healthcare. We then conduct a survey of 18 elite Jordanian hospitals to study the case holistically. Statistical analysis of the survey results confirmed some of what the literature revealed; organizational leadership seems to be the most dominant factor, followed by knowledge of employees about lean, training, and patient satisfaction (customer focus). Another important finding, not captured by the literature, is that lean implementation success depends on educating physicians about continuous improvement and lean and ensuring they are part of the improvement team. Based on the revealed enablers and obstacles, we created a full lean implementation framework. This framework was then used along with selected engineering tools to implement lean in a major hospital successfully. Implementation results showed 60% of reduction in cycle time, 80% reduction in operational cost, and many other benefits.
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21
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Fernandes HMDLG, Jesus MVND, Silva DD, Guirardello EDB. Lean Healthcare in the institutional, professional, and patient perspective: an integrative review. ACTA ACUST UNITED AC 2020; 41:e20190340. [PMID: 32813807 DOI: 10.1590/1983-1447.2020.20190340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 04/28/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To analyze the scientific evidences in the literature about the evaluation of Lean Healthcare after its implementation. METHOD An integrative review conducted in the CINAHL, Scopus, WOS, and Embase databases, and in the PubMed portal, resulting in 18 articles published in English, Spanish and Portuguese, from 2008 to 2019. RESULTS The findings were categorized into results for the institution, professional, and patient. The predominant category was institutional, with cost analysis and increased productivity, followed by the professional, with job satisfaction and leadership, and finally the patient, with satisfaction, attitudes, and behaviors. CONCLUSION This study reinforces the need to establish, for management, a systematic method of monitoring the results achieved in the Lean Healthcare implementation phase. Since the value in this method is defined by the patient, further research in this aspect may lead to new evidence.
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Affiliation(s)
| | - Mariana Véo Nery de Jesus
- Programa de Pós Graduação em Enfermagem, Faculdade de Enfermagem, Universidade Estadual de Campinas, Campinas, São Paulo, Brasil
| | - Dirceu da Silva
- Faculdade de Educação, Universidade Estadual de Campinas, Campinas, São Paulo, Brasil
| | - Edinêis de Brito Guirardello
- Programa de Pós Graduação em Enfermagem, Faculdade de Enfermagem, Universidade Estadual de Campinas, Campinas, São Paulo, Brasil
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22
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Zepeda-Lugo C, Tlapa D, Baez-Lopez Y, Limon-Romero J, Ontiveros S, Perez-Sanchez A, Tortorella G. Assessing the Impact of Lean Healthcare on Inpatient Care: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155609. [PMID: 32759705 PMCID: PMC7432925 DOI: 10.3390/ijerph17155609] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/23/2020] [Accepted: 07/29/2020] [Indexed: 12/16/2022]
Abstract
Healthcare services are facing challenges in increasing their efficiency, quality of care, and coping with surges in demand. To this end, some hospitals have implemented lean healthcare. The aim of this systematic review is to evaluate the effects of lean healthcare (LH) interventions on inpatient care and determine whether patient flow and efficiency outcomes improve. The review was performed according to PRISMA. We used six databases to search for studies published from 2002 to 2019. Out of 5732 studies, 39 measuring one or more defined outcomes were included. Hospital length of stay (LOS) was measured in 23 studies, 16 of which reported a reduction, turnover time (TOT) decreased in six out of eight studies, while the turnaround time (TAT) and on-time starts (OTS) improved in all five and seven studies, respectively. Moreover, eight out of nine studies reported an earlier discharge time, and the boarding time decreased in all four cases. Meanwhile, the readmission rate did not increase in all nine studies. Lastly, staff and patient satisfaction improved in all eight studies. Our findings show that by focusing on reducing non-value-added activities, LH contributed to improving patient flow and efficiency within inpatient care.
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Affiliation(s)
- Carlos Zepeda-Lugo
- Facultad de Ingeniería, Arquitectura y Diseño, Universidad Autónoma de Baja California, Ensenada 22860, Mexico; (C.Z.-L.); (J.L.-R.)
| | - Diego Tlapa
- Facultad de Ingeniería, Arquitectura y Diseño, Universidad Autónoma de Baja California, Ensenada 22860, Mexico; (C.Z.-L.); (J.L.-R.)
- Correspondence: (D.T.); (Y.B.-L.); Tel.: +52-6461750744 (D.T.)
| | - Yolanda Baez-Lopez
- Facultad de Ingeniería, Arquitectura y Diseño, Universidad Autónoma de Baja California, Ensenada 22860, Mexico; (C.Z.-L.); (J.L.-R.)
- Correspondence: (D.T.); (Y.B.-L.); Tel.: +52-6461750744 (D.T.)
| | - Jorge Limon-Romero
- Facultad de Ingeniería, Arquitectura y Diseño, Universidad Autónoma de Baja California, Ensenada 22860, Mexico; (C.Z.-L.); (J.L.-R.)
| | - Sinue Ontiveros
- Facultad de Ciencias de la Ingeniería, Administrativas y Sociales, Universidad Autónoma de Baja California, Tecate 21460, Mexico;
| | - Armando Perez-Sanchez
- Facultad de Ciencias de la Ingeniería y Tecnología, Universidad Autónoma de Baja California, Tijuana 22260, Mexico;
| | - Guilherme Tortorella
- Department of Systems and Production Engineering, Universidade Federal de Santa Catarina, Florianópolis 88040, Brazil;
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Implementing standardised flow: navigating operational and professional dependencies. INTERNATIONAL JOURNAL OF OPERATIONS & PRODUCTION MANAGEMENT 2020. [DOI: 10.1108/ijopm-06-2019-0493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe purpose of this study had two aims: (1) to extend insight regarding the challenges of implementing standardised work, via care pathways, in a healthcare setting by considering interactions with other operational (i.e. resource sharing, portfolio alignment) and professional (i.e. autonomous expertise) dependencies and (2) to develop novel insights regarding a specific flow mechanism, the stroke nurse practitioner, a form of flow “pilo” or guide.Design/methodology/approachThis was a longitudinal case study of implementing the acute stroke care pathway in a National Health Service hospital in England based on 185 hours of non-participant observations and 68 semi-structured interviews. Archival documents were also analysed.FindingsThe combined flow, operational and professional dependency lens extends operations management understanding of the challenge of implementing standardised work in healthcare. One observed practice, the process pilot role, may be particularly valuable in dealing with these dependencies but it requires specific design and continuous support, for which the authors provide some initial guidance.Research limitations/implicationsThe research was a single case study and was focussed on a single care pathway. The findings require replication and extension but offer a novel set of insights into the implications of standardised work in healthcare.Originality/valueIn addition to confirming that a multidependency lens adds conceptual and practical insight to the challenges of implementing standardised work in a healthcare setting, the findings and recommendations regarding flow “pilots” are novel. The authors' analysis of this role reveals new insights regarding the need for continued improvisation in standardised work.
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Smith I, Hicks C, McGovern T. Adapting Lean methods to facilitate stakeholder engagement and co-design in healthcare. BMJ 2020; 368:m35. [PMID: 31992550 PMCID: PMC7190378 DOI: 10.1136/bmj.m35] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Iain Smith
- Newcastle University Business School, University of Newcastle upon Tyne, Newcastle upon Tyne, NE1 4SE, UK
| | - Chris Hicks
- Newcastle University Business School, University of Newcastle upon Tyne, Newcastle upon Tyne, NE1 4SE, UK
| | - Tom McGovern
- Newcastle University Business School, University of Newcastle upon Tyne, Newcastle upon Tyne, NE1 4SE, UK
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Martínez-Rodríguez A, Martínez-Faneca L, Casafont-Bullich C, Olivé-Ferrer MC. Construction of nursing knowledge in commodified contexts: A discussion paper. Nurs Inq 2020; 27:e12336. [PMID: 31976615 DOI: 10.1111/nin.12336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 11/15/2019] [Accepted: 11/17/2019] [Indexed: 01/24/2023]
Abstract
This original article outlines a theoretical path and posterior critical analysis regarding two relevant matters in modern nursing: patterns of knowing in nursing and commodification contexts in contemporary health systems. The aim of our manuscript is to examine the development of basic and contextual nursing knowledge in commodified contexts. For this purpose, we outline a discussion and reflexive dialogue based on a literature search and our clinical experience. To lay the foundation for an informed discussion, we conducted a literature search and selected relevant articles in English, Spanish, and Portuguese that included contents on patterns of knowing, commodification, and nursing published from 1978 to 2017. Globalization, commodification, and austerity measures seem to have negative effects on nursing. Work conditions are worsening, deteriorating nurse-patient relationships, and limiting reflection on practice. Nurses must develop knowledge to challenge and participate in institutional organization and public health policies. Development of nursing knowledge may be difficult to achieve in commodified environments. Consequently, therapeutic care relationships, healthcare services, and nurses' own health are compromised. However, by obtaining organizational, sociopolitical, and emancipatory knowledge, nurses can use strategies to adapt to or resist commodified contexts while constructing basic knowledge.
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Affiliation(s)
- Ana Martínez-Rodríguez
- Departament d'infermeria fonamental i mèdicoquirúrgica, Facultat de Medicina i Ciències de la Salut, Escola d'Infermeria, Universitat de Barcelona, Barcelona, Spain.,Hospital Clínic de Barcelona, Barcelona, Spain
| | | | | | - Maria Carmen Olivé-Ferrer
- Departament d'infermeria fonamental i mèdicoquirúrgica, Facultat de Medicina i Ciències de la Salut, Escola d'Infermeria, Universitat de Barcelona, Barcelona, Spain
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Weyker PD, Webb CAJ. Establishing a patient centered, outpatient total joint home recovery program within an integrated healthcare system. Pain Manag 2019; 10:23-41. [PMID: 31852383 DOI: 10.2217/pmt-2019-0040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Outpatient total joint home recovery (HR) is a rapidly growing initiative being developed and employed at high volume orthopedic centers. Minimally invasive surgery, improved pain control and home health services have made HR possible. Multidisciplinary teams with members ranging from surgeons and anesthesiologists to hospital administrators, physical therapists, nurses and research analysts are necessary for success. Eligibility criteria for outpatient total joint arthroplasty will vary between medical centers. Surgeon preference in addition to medical comorbidities, social support, preoperative patient mobility and safety of the HR location are all factors to consider when selecting patients for outpatient total joint HR. As additional knowledge is gained, the next steps will be to establish 'best practices' and speciality society-endorsed guidelines for patients undergoing outpatient total joint arthroplasty.
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Affiliation(s)
- Paul David Weyker
- Department of Anesthesia & Perioperative Medicine, The Permanente Medical Group of Northern California, South San Francisco, CA 94080, USA.,Department of Clinical Sciences, Kaiser Permanente School of Medicine, Pasadena, CA 91101, USA
| | - Christopher Allen-John Webb
- Department of Clinical Sciences, Kaiser Permanente School of Medicine, Pasadena, CA 91101, USA.,Department of Anesthesia & Perioperative Medicine, The Permanente Medical Group of Northern California, South San Francisco, CA 94080, USA.,Department of Anesthesia & Perioperative Care, University of California San Francisco, San Francisco, CA 94143, USA
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27
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Peimbert-García RE, Matis T, Beltran-Godoy JH, Garay-Rondero CL, Vicencio-Ortiz JC, López-Soto D. Assessing the state of lean and six sigma practices in healthcare in Mexico. Leadersh Health Serv (Bradf Engl) 2019; 32:644-662. [PMID: 31612788 DOI: 10.1108/lhs-02-2019-0011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study is to assess the state at which lean and six sigma (LSS) are used as a management system to improve the national health system national health system of Mexico. DESIGN/METHODOLOGY/APPROACH Cross-sectional survey-research. The survey was administered at 30 different hospitals across six states in Mexico. These were selected using convenience sampling and participants (N = 258) were selected through random/snowball sampling procedures, including from top managers down to front-line staff. FINDINGS Only 16 per cent of respondents reported participation in LSS projects. Still, these implementations are limited to using isolated tools, mainly 5s, failure mode and effects analysis (FMEA) and Fishbone diagram, with the lack of training/knowledge and financial resources as the top disabling factors. Overall, LSS has not become systematic in daily management and operations. RESEARCH LIMITATIONS/IMPLICATIONS The sampling procedure was by convenience; however, every attempt was made to ensure a lack of bias in the individual responses. If still there was a bias, it is conjectured that this would likely be in overestimating the penetration of LSS. PRACTICAL IMPLICATIONS The penetration of LSS management practices into the Mexican health system is in its infancy, and the sustainability of current projects is jeopardized given the lack of systematic integration. Hence, LSS should be better spread and communicated across healthcare organizations in Mexico. ORIGINALITY/VALUE This is the first research work that evaluates the use of LSS management practices in a Latin American country, and the first journal paper that focuses on LSS in healthcare in Mexico.
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Affiliation(s)
| | - Timothy Matis
- Department of Industrial Engineering, Texas Tech University , Lubbock, Texas, USA
| | - Jaime H Beltran-Godoy
- Department of Business and Economics, Universidad Anáhuac México , México City, México
| | | | | | - Diana López-Soto
- School of Engineering and Sciences , Tecnológico de Monterrey, Hermosillo, México
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Kaltenbrunner M, Bengtsson L, Mathiassen SE, Högberg H, Engström M. Staff perception of Lean, care-giving, thriving and exhaustion: a longitudinal study in primary care. BMC Health Serv Res 2019; 19:652. [PMID: 31500624 PMCID: PMC6734292 DOI: 10.1186/s12913-019-4502-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 08/30/2019] [Indexed: 11/30/2022] Open
Abstract
Background Lean is commonly adopted in healthcare to increase quality of care and efficiency. Few studies of Lean involve staff-related outcomes, and few have a longitudinal design. Thus, the aim was to examine the extent to which changes over time in Lean maturity are associated with changes over time in care-giving, thriving and exhaustion, as perceived by staff, with a particular emphasis on the extent to which job demands and job resources, as perceived by staff, have a moderated mediation effect. Method A longitudinal study with a correlational design was used. In total, 260 staff at 46 primary care units responded to a web survey in 2015 and 2016. All variables in the study were measured using staff ratings. Ratings of Lean maturity reflect participants’ judgements regarding the entire unit; ratings of care-giving, thriving, exhaustion and job demands and resources reflect participants’ judgements regarding their own situation. Results First, over time, increased Lean maturity was associated with increased staff satisfaction with their care-giving and increased thriving, mediated by increased job resources. Second, over time, increased Lean maturity was associated with decreased staff exhaustion, mediated by decreased job demands. No evidence was found showing that job demands and job resources had a moderated mediation effect. Conclusion The results indicate that primary care staff may benefit from working in organizations characterized by high levels of Lean maturity and that caregiving may also be improved as perceived by staff. Electronic supplementary material The online version of this article (10.1186/s12913-019-4502-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Monica Kaltenbrunner
- Department of Occupational Health Sciences and Psychology, Faculty of Health and Occupational Studies, University of Gävle, 801 76, Gävle, Sweden.
| | - Lars Bengtsson
- Department of Industrial Management, Industrial Design and Mechanical Engineering, Faculty of Engineering and Sustainable Development, University of Gävle, 801 76, Gävle, Sweden
| | - Svend Erik Mathiassen
- Department of Occupational Health Sciences and Psychology, Faculty of Health and Occupational Studies, University of Gävle, 801 76, Gävle, Sweden
| | - Hans Högberg
- Department of Caring Science, Faculty of Health and Occupational Studies, University of Gävle, 801 76, Gävle, Sweden
| | - Maria Engström
- Department of Caring Science, Faculty of Health and Occupational Studies, University of Gävle, 801 76, Gävle, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,Nursing Department, Medicine and Health College, Lishui University, Lishui, China
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Akinluyi EA, Ison K, Clarkson PJ. Mapping outcomes in quality improvement and system design activities: the outcome identification loop and system impact model. BMJ Open Qual 2019; 8:e000439. [PMID: 31544162 PMCID: PMC6730601 DOI: 10.1136/bmjoq-2018-000439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/06/2019] [Accepted: 08/09/2019] [Indexed: 11/15/2022] Open
Abstract
Background Whether explicit or implicit, models of value are fundamental in quality improvement (QI) initiatives. They embody the desirability of the impact of interventions—with either foresight or hindsight. Increasingly impact is articulated in terms of outcomes, which are often prescribed and sometimes inappropriate. Currently, there is little methodological guidance for deriving an appropriate set of outcomes for a given QI initiative. This paper describes a structured approach for identifying and mapping outcomes. Overall approach Central to the approach presented here is the engagement of teams in the exploration of the system that is being designed into. This methodology has emerged from the analysis and abstraction of existing methods that define systems in terms of outcomes, stakeholders and their analogues. It is based on a sequence of questions that underpin these methods. Outcome elicitation tools The fundamental questions of outcome elicitation can be concatenated into a structured process, within the Outcome Identification Loop. This system-analysis process stimulates new insights that can be captured within a System Impact Model. The System Impact Model reconciles principles of intended cause/effect, with knowledge of unintended effects more typically emphasised by risk approaches. This system representation may be used to select sets of outcomes that signify the greatest impact on patients, staff and other stakeholders. It may also be used to identify potential QI interventions and to forecast their impact. Discussion and conclusions The Outcome Identification Loop has proven to be an effective tool for designing workshops and interviews that engage stakeholders, critically in the early stages of QI planning. By applying this process in different ways, existing knowledge is captured in System Impact Models and mobilised towards QI endeavours.
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Affiliation(s)
| | - Keith Ison
- Medical Physics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - P John Clarkson
- Department of Engineering, University of Cambridge, Cambridge, UK
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Sarre S, Maben J, Griffiths P, Chable R, Robert G. The 10-year impact of a ward-level quality improvement intervention in acute hospitals: a multiple methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
The ‘Productive Ward: Releasing Time to Care’™ programme (Productive Ward; PW) was introduced in English NHS acute hospitals in 2007 to give ward staff the tools, skills and time needed to implement local improvements to (1) increase the time nurses spend on direct patient care, (2) improve the safety and reliability of care, (3) improve staff and patient experience and (4) make structural changes on wards to improve efficiency. Evidence of whether or not these goals were met and sustained is very limited.
Objective
To explore if PW had a sustained impact over the past decade.
Design
Multiple methods, comprising two online national surveys, six acute trust case studies (including a secondary analysis of local audit data) and telephone interviews.
Data sources
Surveys of 56 directors of nursing and 35 current PW leads; 88 staff and patient and public involvement representative interviews; 10 ward manager questionnaires; structured observations of 12 randomly selected wards and documentary analysis in case studies; and 14 telephone interviews with former PW leads.
Results
Trusts typically adopted PW in 2008–9 on their wards using a phased implementation approach. The average length of PW use was 3 years (range < 1 to 7 years). Financial and management support for PW has disappeared in the majority of trusts. The most commonly cited reason for PW’s cessation was a change in quality improvement (QI) approach. Nonetheless, PW has influenced wider QI strategies in around half of the trusts. Around one-third of trusts had impact data relating specifically to PW; the same proportion did not. Early adopters of PW had access to more resources for supporting implementation. Some elements of local implementation strategies were common. However, there were variations that had consequences for the assimilation of PW into routine practice and, subsequently, for the legacies and sustainability of the programme. In all case study sites, material legacies (e.g. display of metrics data; storage systems) remained, as did some processes (e.g. protected mealtimes). Only one case study site had sufficiently robust data collection systems to allow an objective assessment of PW’s impact; in that site, care processes had improved initially (in terms of patient observations and direct care time). Experience of leading PW had benefited the careers of the majority of interviewees. Starting with little or no QI experience, many went on to work on other initiatives within their trusts, or to work in QI at regional or national level within the NHS or in the private sector.
Limitations
The research draws on participant recall over a lengthy period characterised by evolving QI approaches and system-level change.
Conclusions
Little robust evidence remains of PW leading to a sustained increase in the time nurses spend on direct patient care or improvements in the experiences of staff and/or patients. PW has had a lasting impact on some ward practices. As an ongoing QI approach continually used to make ongoing improvements, PW has not been sustained, but it has informed current organisational QI practices and strategies in many trusts. The design and delivery of future large-scale QI programmes could usefully draw on the lessons learnt from this study of the PW in England over the period 2008–18.
Funding
This National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Sophie Sarre
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, London, UK
| | - Jill Maben
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | | | - Rosemary Chable
- Training, Development & Workforce, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Glenn Robert
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, London, UK
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Alami H, Gagnon MP, Fortin JP. [Organizational and systemic conditions of citizen-patient involvement in the development of telehealth in Quebec]. SANTE PUBLIQUE 2019; Vol. 31:125-135. [PMID: 31210508 DOI: 10.3917/spub.191.0125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES Involving citizens-patients in decisions regarding telehealth services could allow a better match between the services offered and the needs and contexts of individuals and communities. This study aims to explore the organizational and systemic conditions that can influence citizen-patient involvement in the development of telehealth in Quebec. METHODS A qualitative study based on semi-structured interviews with 29 key informants was conducted. A deductive-inductive thematic analysis was performed based on an integrative framework derived from diffusion of innovation theories. RESULTS Citizen-patient involvement in the development of telehealth remains dependent on many organizational and systemic conditions. At the organizational level, it could affect the dynamics, process, cultures, rules and operations in organizations; hence the needs for adequate human and material resources as well as the availability of support for change. At the systemic level, the ideology, the sociopolitical context and the decisions in favor (or not) of a citizen appropriation of the decision-making are central. Concerns about scientific evidence, training, as well as the roles of professional federations, and citizen-patient groups have also emerged. Organizational and systemic levels are interdependent. CONCLUSION The organizational and systemic contexts may explain part of the contrast between the discourse in favor of citizen-patient involvement in telehealth decision-making and the reality observed in Quebec. This study provides a basis for analyzing citizen-patient involvement in services development from the perspective of organizational and systemic changes.
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Munar W, Snilstveit B, Stevenson J, Biswas N, Eyers J, Butera G, Baffour T, Aranda LE. Evidence gap map of performance measurement and management in primary care delivery systems in low- and middle-income countries - Study protocol. Gates Open Res 2018; 2:27. [PMID: 29984360 PMCID: PMC6030397 DOI: 10.12688/gatesopenres.12826.2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2018] [Indexed: 11/20/2022] Open
Abstract
Background . For the last two decades there has been growing interest in governmental and global health stakeholders about the role that performance measurement and management systems can play for the production of high-quality and safely delivered primary care services. Despite recognition and interest, the gaps in evidence in this field of research and practice in low- and middle-income countries remain poorly characterized. This study will develop an evidence gap map in the area of performance management in primary care delivery systems in low- and middle-income countries. Methods. The evidence gap map will follow the methodology developed by 3Ie, the International Initiative for Impact Evaluation, to systematically map evidence and research gaps. The process starts with the development of the scope by creating an evidence-informed framework that helps identify the interventions and outcomes of relevance as well as help define inclusion and exclusion criteria. A search strategy is then developed to guide the systematic search of the literature, covering the following databases: Medline (Ovid), Embase (Ovid), CAB Global Health (Ovid), CINAHL (Ebsco), Cochrane Library, Scopus (Elsevier), and Econlit (Ovid). Sources of grey literature are also searched. Studies that meet the inclusion criteria are systematically coded, extracting data on intervention, outcome, measures, context, geography, equity, and study design. Systematic reviews are also critically appraised using an existing standard checklist. Impact evaluations are not appraised but will be coded according to study design. The process of map-building ends with the creation of an evidence gap map graphic that displays the available evidence according to the intervention and outcome framework of interest. Discussion . Implications arising from the evidence map will be discussed in a separate paper that will summarize findings and make recommendations for the development of a prioritized research agenda.
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Affiliation(s)
- Wolfgang Munar
- Milken Institute School of Public Health, Department of Global Health, George Washington University, Washington, DC, 20052, USA
| | - Birte Snilstveit
- International Initiative for Impact Evaluation (3Ie), London International Development Centre, London, WC1H 0PD, UK
| | - Jennifer Stevenson
- International Initiative for Impact Evaluation (3Ie), London International Development Centre, London, WC1H 0PD, UK
| | - Nilakshi Biswas
- Milken Institute School of Public Health, Department of Global Health, George Washington University, Washington, DC, 20052, USA
| | - John Eyers
- International Initiative for Impact Evaluation (3Ie), London International Development Centre, London, WC1H 0PD, UK
| | - Gisela Butera
- Milken Institute School of Public Health, Department of Global Health, George Washington University, Washington, DC, 20052, USA
| | - Theresa Baffour
- Milken Institute School of Public Health, Department of Global Health, George Washington University, Washington, DC, 20052, USA
| | - Ligia E Aranda
- Milken Institute School of Public Health, Department of Global Health, George Washington University, Washington, DC, 20052, USA
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Damián Sanz M, Yagüe‐Fabra JA, Gracia Matilla R. Use of Lean techniques in health care in Spain to improve involvement and satisfaction of workers. Int J Health Plann Manage 2018; 34:e274-e290. [DOI: 10.1002/hpm.2646] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 08/06/2018] [Accepted: 08/07/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - Rosa Gracia Matilla
- Hospital Universitario Miguel Servet. Paseo Isabel la Católica Zaragoza Spain
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35
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Munar W, Snilstveit B, Stevenson J, Biswas N, Eyers J, Butera G, Baffour T, Aranda LE. Evidence gap map of performance measurement and management in primary care delivery systems in low- and middle-income countries - Study protocol. Gates Open Res 2018; 2:27. [PMID: 29984360 PMCID: PMC6030397 DOI: 10.12688/gatesopenres.12826.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2018] [Indexed: 10/12/2023] Open
Abstract
Background. For the last two decades there has been growing interest in governmental and global health stakeholders about the role that performance measurement and management systems can play for the production of high-quality and safely delivered primary care services. Despite recognition and interest, the gaps in evidence in this field of research and practice in low- and middle-income countries remain poorly characterized. This study will develop an evidence gap map in the area of performance management in primary care delivery systems in low- and middle-income countries. Methods. The evidence gap map will follow the methodology developed by 3Ie, the International Initiative for Impact Evaluation, to systematically map evidence and research gaps. The process starts with the development of the scope by creating an evidence-informed framework that helps identify the interventions and outcomes of relevance as well as help define inclusion and exclusion criteria. A search strategy is then developed to guide the systematic search of the literature, covering the following databases: Medline (Ovid), Embase (Ovid), CAB Global Health (Ovid), CINAHL (Ebsco), Cochrane Library, Scopus (Elsevier), and Econlit (Ovid). Sources of grey literature are also searched. Studies that meet the inclusion criteria are systematically coded, extracting data on intervention, outcome, measures, context, geography, equity, and study design. Systematic reviews are also critically appraised using an existing standard checklist. Impact evaluations are not appraised but will be coded according to study design. The process of map-building ends with the creation of an evidence gap map graphic that displays the available evidence according to the intervention and outcome framework of interest. Discussion. Applications arising from the evidence map will be discussed in a separate paper that will summarize findings and make recommendations for the development of a prioritized research agenda.
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Affiliation(s)
- Wolfgang Munar
- Milken Institute School of Public Health, Department of Global Health, George Washington University, Washington, DC, 20052, USA
| | - Birte Snilstveit
- International Initiative for Impact Evaluation (3Ie), London International Development Centre, London, WC1H 0PD, UK
| | - Jennifer Stevenson
- International Initiative for Impact Evaluation (3Ie), London International Development Centre, London, WC1H 0PD, UK
| | - Nilakshi Biswas
- Milken Institute School of Public Health, Department of Global Health, George Washington University, Washington, DC, 20052, USA
| | - John Eyers
- International Initiative for Impact Evaluation (3Ie), London International Development Centre, London, WC1H 0PD, UK
| | - Gisela Butera
- Milken Institute School of Public Health, Department of Global Health, George Washington University, Washington, DC, 20052, USA
| | - Theresa Baffour
- Milken Institute School of Public Health, Department of Global Health, George Washington University, Washington, DC, 20052, USA
| | - Ligia E. Aranda
- Milken Institute School of Public Health, Department of Global Health, George Washington University, Washington, DC, 20052, USA
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Blackmore CC, Kaplan GS. Lean and the perfect patient experience. BMJ Qual Saf 2016; 26:85-86. [DOI: 10.1136/bmjqs-2016-005273] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2016] [Indexed: 11/03/2022]
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