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AlHarthy SH, Ayaad O, Al Mashari AAA, AlBalushi MA, Ibrahim R, Bait Nasib MH, Al Zadjali R, Al-Awaisi H, Al Baimani K. Improving Care Continuity in Oncology Settings: A Lean Management Approach to Minimize Discharges Without Follow-Up Appointments. Asian Pac J Cancer Prev 2024; 25:1293-1300. [PMID: 38679990 PMCID: PMC11162702 DOI: 10.31557/apjcp.2024.25.4.1293] [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: 10/29/2023] [Accepted: 04/16/2024] [Indexed: 05/01/2024] Open
Abstract
OBJECTIVE This study aimed to reduce the number of patients discharged without scheduled follow-up appointments by implementing lean management principles. METHODS Conducted at the Sultan Qaboos Comprehensive Cancer Center in Muscat, Oman, the research utilized a one-group pretest-posttest quasi-experimental design to evaluate the impact of lean management interventions on the rate of patient discharges without follow-up appointments. Strategies such as the Kaizen principle, Gemba Walks, cross-functional collaboration, standard work procedures, and waste reduction were employed to enhance operational efficiency. RESULTS Spanning from Quarter 3 of 2022 to Quarter 2 of 2023, the study demonstrated a significant decrease in the percentage of patients discharged without planned follow-up appointments. The rate dropped from 9% in September 2022 to 0% in March 2023, with statistically significant differences observed (X2= 65.05, p value=<.0001). CONCLUSION By effectively implementing lean management principles, this research successfully enhanced care continuity for oncology patients after being discharged.
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Affiliation(s)
- Shinnona Hamed AlHarthy
- Admission, Discharge, and Transfer Office, Sultan Qaboos Comprehensive Cancer Care and Research Centre (SQCCCRC), Muscat, Oman.
| | - Omar Ayaad
- Quality and Accreditation Department, Sultan Qaboos Comprehensive Cancer Care and Research Centre (SQCCCRC), Muscat, Oman.
| | - Al Ameer Ahmed Al Mashari
- Admission, Discharge, and Transfer Office, Sultan Qaboos Comprehensive Cancer Care and Research Centre (SQCCCRC), Muscat, Oman.
| | - Muna Ali AlBalushi
- Department of Nursing, Sultan Qaboos Comprehensive Cancer Care and Research Centre (SQCCCRC), Muscat, Oman.
| | - Rawan Ibrahim
- Quality and Accreditation Department, Sultan Qaboos Comprehensive Cancer Care and Research Centre (SQCCCRC), Muscat, Oman.
| | - Mohammed Hassan Bait Nasib
- Admission, Discharge, and Transfer Office, Sultan Qaboos Comprehensive Cancer Care and Research Centre (SQCCCRC), Muscat, Oman.
| | - Razzan Al Zadjali
- Quality and Accreditation Department, Sultan Qaboos Comprehensive Cancer Care and Research Centre (SQCCCRC), Muscat, Oman.
| | - Huda Al-Awaisi
- Department of Nursing, Sultan Qaboos Comprehensive Cancer Care and Research Centre (SQCCCRC), Muscat, Oman.
| | - Khalid Al Baimani
- Quality and Accreditation Department, Sultan Qaboos Comprehensive Cancer Care and Research Centre (SQCCCRC), Muscat, Oman.
- Medical Oncology Department, Sultan Qaboos Comprehensive Cancer Care and Research Centre (SQCCCRC), Muscat, Oman.
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Neumann W, Purdy N. The better work, better care framework: 7 strategies for sustainable healthcare system process improvement. Health Syst (Basingstoke) 2023; 12:429-445. [PMID: 38235296 PMCID: PMC10791105 DOI: 10.1080/20476965.2023.2198580] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/23/2023] [Indexed: 01/19/2024] Open
Abstract
Healthcare systems are under pressure to control costs and improve performance. Efforts to apply improvement trends such as "Lean" and other industrial engineering approaches have led to degradation of the working environment for healthcare professionals. Research is increasingly demonstrating how poor working environments contribute to declines in care quality and has led to calls for a "quadruple aim" with a focus on the working environment alongside quality, cost, and patient experience factors. This paper contributes to the debate by using a "systems" perspective to propose seven strategies by which healthcare systems might be improved without compromising the working environment. This article presents a rationale for these strategies based on current organisational psychology and human factors research and how these strategies might be deployed in practice. The authors argue that better working conditions leads to better care for patients and presents a viable approach for both practitioners and researchers to pursue the "Better Work, Better Care" agenda.
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Affiliation(s)
- W.P. Neumann
- Department of Mechanical and Industrial Engineering, Toronto Metropolitan University, Toronto, ON, Canada
| | - N. Purdy
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Ontario, Canada
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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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Ward ME, Daly A, McNamara M, Garvey S, Teeling SP. A Case Study of a Whole System Approach to Improvement in an Acute Hospital Setting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1246. [PMID: 35162269 PMCID: PMC8835196 DOI: 10.3390/ijerph19031246] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 11/16/2022]
Abstract
Changes in healthcare tend to be project-based with whole system change, which acknowledges the interconnectedness of socio-technical factors, not the norm. This paper attempts to address the question of whole system change posed by the special issue and brings together other research presented in this special issue. A case study approach was adopted to understand the deployment of a whole system change in the acute hospital setting along four dimensions of a socio-technical systems framework: culture, system functioning, action, and sense-making. The case study demonstrates evidence of whole system improvement. The approach to change was co-designed by staff and management, projects involving staff from all specialities and levels of seniority were linked to each other and to the strategic objectives of the organisation, and learnings from first-generation projects have been passed to second and third-generation process improvements. The socio-technical systems framework was used retrospectively to assess the system change but could also be used prospectively to help healthcare organisations develop approaches to whole system improvement.
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Affiliation(s)
- Marie E Ward
- Centre for Innovative Human Systems, School of Psychology, Trinity College, The University of Dublin, D02 PN40 Dublin, Ireland
| | - Ailish Daly
- Beacon Hospital, Sandyford, D18 AK68 Dublin, Ireland
| | - Martin McNamara
- UCD Centre for Interdisciplinary Research, Education & Innovation in Health Systems, School of Nursing, Midwifery & Health Systems, UCD Health Sciences Centre, University College Dublin, D04 V1W8 Dublin, Ireland
| | | | - Sean Paul Teeling
- UCD Centre for Interdisciplinary Research, Education & Innovation in Health Systems, School of Nursing, Midwifery & Health Systems, UCD Health Sciences Centre, University College Dublin, D04 V1W8 Dublin, Ireland
- Centre for Person-Centred Practice Research Division of Nursing, School of Health Sciences, Queen Margaret University, Queen Margaret University Drive, Musselburgh EH21 6UU, UK
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Sillner AY, Madrigal C, Behrens L. Person-Centered Gerontological Nursing: An Overview Across Care Settings. J Gerontol Nurs 2021; 47:7-12. [PMID: 33497445 DOI: 10.3928/00989134-20210107-02] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Person-centered care (PCC) is the gold standard in care delivery for all people, including older adults. Key players, such as the National Academies of Sciences, Engineering, and Medicine, the Institute for Healthcare Improvement, and the Centers for Medicare & Medicaid, have highlighted PCC as a means to better meet people's needs and improve their quality of care. Nurses are often a person's primary point of contact throughout their care trajectory, thus essential in planning, coordinating, and delivering PCC. However, limited literature focuses on the application and evaluation of nursing-related PCC for older adults. The current article aims to provide a nursing-focused conceptual review of PCC for older adults across care settings. This review describes PCC from a gerontological nursing perspective and presents setting-specific approaches and person-centered nursing practice outcomes. [Journal of Gerontological Nursing, 47(2), 7-12.].
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Olanipekun T. The impact of COVID-19 testing on length of hospital stay and patient flow in hospitals. J Community Hosp Intern Med Perspect 2021; 11:180-183. [PMID: 33889316 PMCID: PMC8043527 DOI: 10.1080/20009666.2020.1866249] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
The CDC regularly updates guidance on COVID-19 testing for inpatients and hospital discharges to nursing homes and long-term care facilities. However, most long-term care facilities require a negative COVID-19 test result before accepting patients discharged from the hospital which directly contravenes the CDC guidelines. Due to delays in COVID-19 testing and obtaining test results, patients end up staying additional 2–3 days in the hospital before they can be discharged to nursing care facilities. Furthermore, hospitals have reported facing resistance from health insurance plans to paying for patients’ additional days in the hospital while awaiting COVID-19 test results. Hospitals across the country continue to experience an increase in hospitalizations for COVID-19 infection. Complying with the CDC guidance on testing and disposition of patients may prevent delays in transferring patients to long-term lower acuity level nursing facilities, reduce the length of hospital stay, improve patient flow and ultimately free up hospital beds for incoming COVID-19 patients.
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Affiliation(s)
- Titilope Olanipekun
- Department of Internal Medicine, Covenant Health System, Knoxville, Tennessee, USA
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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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Udod SA, Duchscher JB, Goodridge D, Rotter T, McGrath P, Hewitt AD. Nurse managers implementing the lean management system: A qualitative study in Western Canada. J Nurs Manag 2020; 28:221-228. [PMID: 31680367 PMCID: PMC7328733 DOI: 10.1111/jonm.12898] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 10/22/2019] [Accepted: 10/31/2019] [Indexed: 11/30/2022]
Abstract
AIM This study explores the perceptions and experiences of nurse managers involved in implementing the Lean management system in a Western Canadian province. BACKGROUND The provincial government of Saskatchewan, Canada, implemented a multimillion-dollar investment in the Lean management system to transform health care delivery by reducing waste and increasing efficiency of processes and outcomes. METHODS This qualitative exploratory study employed semi-structured interviews with 14 nurse managers in urban and rural health regions in one Canadian province. RESULTS Six themes outline the difficulties nurse managers experienced in juggling role responsibilities alongside a poorly implemented change system with scarce resources. CONCLUSION The results showed tensions in the implementation of a Lean model adapted in the context of health care organisations. The expectations for nurse managers to be pivotal players in the implementation of transformative health care practices that promote and sustain strategies to reduce waste, improve coordination and increase patient safety require investment in leadership development. IMPLICATIONS FOR NURSING MANAGEMENT Lean management systems significantly impact the roles of nurse managers who require adequate resources and training to successfully adapt. The results of this study may be used for more effective support mechanisms for nurse managers.
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Affiliation(s)
- Sonia A Udod
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba, Winnipeg, MB, Canada
| | | | | | - Thomas Rotter
- Health Quality Programs, Queen's University, Kingston, ON, Canada
| | - Petrina McGrath
- Quality and Safety, Saskatchewan Health Authority, Saskatoon City Hospital, Saskatoon, SK, Canada
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