Managing inpatient bed setup: an action-research approach using lean technical practices and lean social practices

PURPOSE

This article aims to introduce a guide to improving hospital bed setup by combining lean technical practices (LTPs), such as kaizen and value stream mapping (VSM) and lean social practices (LSPs), such as employee empowerment.

DESIGN/METHODOLOGY/APPROACH

Action research approach was employed to analyze the process of reconfiguration of bed setup management in a Brazilian public hospital.

FINDINGS

The study introduces three contributions: (1) presents the use of VSM focused specifically on bed setup, while the current literature presents studies mainly focused on patient flow management, (2) combines the use of LSPs and LTPs in the context of bed management, expanding current studies that are focused either on mathematical models or on social and human aspects of work, (3) introduces a practical guide based on six steps that combine LSPs and LSPs to improve bed setup management.

RESEARCH LIMITATIONS/IMPLICATIONS

The research focused on the analysis of patient beds. Surgical beds, delivery, emergency care and intensive care unit (ICU) were not considered in this study. In addition, the process indicators analyzed after the implementation of the improvements did not contemplate the moment of the COVID-19 pandemic. Finally, this research focused on the implementation of the improvement in the context of only one Brazilian public hospital.

PRACTICAL IMPLICATIONS

The combined use of LSPs and LTPs can generate considerable gains in bed setup efficiency and consequently increase the capacity of a hospital to admit new patients, without the ampliation of the physical space and workforce.

SOCIAL IMPLICATIONS

The improvement of bed setup has an important social character, whereas it can generate important social benefits such as the improvement of the admission service to patients, reducing the waiting time, reducing hospitalization costs and improving the hospital capacity without additional physical resources. All these results are crucial for populations, their countries and regions.

ORIGINALITY/VALUE

While the current literature on bed management is more focused on formal models or pure human and social perspectives, this article brings these two perspectives together in a single, holistic framework. As a result, this article points out that the complex bed management problem can be efficiently solved by combining LSPs and LTPs to present theoretical and practical contributions to the important social problem of hospital bed management.

Purchasing challenges in times of COVID-19: resilience practices to mitigate disruptions in the health-care supply chain

Purpose

This study aims to identify supply chain (SC) management practices applied to purchasing capable of improving the resilience of the health-care SC and mitigating the effects of material and service disruption during pandemics.

Design/methodology/approach

The approach adopted is qualitative and is based on a systematic literature review from the ScienceDirect, Emerald, Wiley and Web of Science databases. After selecting 705 documents, filters are applied, and 52 articles present problems faced by purchasing the health-care SC during the coronavirus disease 2019 (COVID-19) pandemic.

Findings

This article suggests five propositions of resilient practices that can increase purchasing resilience in the face of pandemics such as COVID-19. The proposed practices are collaboration, flexibility, visibility, agility and information sharing, which suggest a sequence for the adoption of management practices based on the number of occurrences and importance found in the analysed studies.

Research limitations/implications

This study does not find robust empirical evidence that could categorically state that the results can be replicated in organisations in general. Thus, as a continuation of research, more studies should use an empirical methodology and case analysis to organise different branches. As the human factor was decisive for the results observed in the literature, future research should dedicate part of the studies to the psychological area of professionals. Actions to combat the pandemic were implemented, impacting positively and negatively on the results obtained. Future research on combat actions could indicate which ones should be avoided.

Practical implications

As a result, disruptions are expected to be reduced, and consequently, the resilience of the SC will increase. Accordingly, purchasing processes and procedures can be redefined to positively influence the resilience of the health-care SC. Resilience is related to maintaining the flow of supply, as well as systems and actions aimed at mitigating the effects of disruptions in the hospital’s core business.

Social implications

Health systems need to respond to society’s needs even in the face of global crises, such as the one faced during the COVID-19 pandemic. The overload in hospitals and the exponential demand for specific medicines and services in the fight against the crisis caused by the COVID-19 pandemic require enormous coordination in procurement by the purchasing sector. This planning aims to ensure that the care provided by health services maintains the flow of value that serves hospitalised patients.

Originality/value

This study introduces a new approach to the recurrent problem of disruption of the health-care SC during a pandemic using a combination of five important management practices. This proves useful for mitigating disruptions and their effects on the health-care SC.

Application of Quality Function Deployment as an Integrative Method to Knowledge Management Implementation

Knowledge Management Implementation (KMI) can be analysed from three perspectives: Knowledge Management System (KMS) implementation, Knowledge Management Processes (KMPs) implementation and Organisational Outcomes (OO). Quality Function Deployment (QFD), conceived within the scope of quality, represents a method capable of bringing significant contributions to the knowledge field of KMI. The QFD method stands out as a comprehensive approach to improve the quality of products and services, focussing on customer requirements. The literature presents a scarcity of studies that discuss the KMI implementation process, addressing these three perspectives. Furthermore, studies that address QFD in the context of KM are more focussed on the KMS implementation perspective. In this context, this research proposes an innovative approach adopting QFD in order to structure the KMI, encompassing the three perspectives presented (KMS implementation, KMP implementation and OO). In this context, QFD is seen as a method of integrating and operationalising KMI activities. To validate this approach, we applied the case study in an academic support department at a Brazilian public university. As a result, it was possible to verify that the QFD helps in the operationalisation of the KMS and KMP and also improves OO. Still, it was observed that the approach to knowledge management seems to be easy to apply in the academic setting and has produced good results in the service offered in the department where it was applied.