1
|
Zeng J, Zhang J, Li R, Guo ZH, Wu F, Wang SM, Zhang HY, Qian FH. Factors influencing the continuity of evidence-based practice in perioperative airway management for elderly patients with fractures: A qualitative study. World J Clin Cases 2024; 12:5032-5041. [DOI: 10.12998/wjcc.v12.i22.5032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 05/11/2024] [Accepted: 06/04/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND More and more evidence-based practices are emerging, but researchers mostly focus on short-term effects, resulting in evidence-based practices not being applied in the clinic in the long term. In this study, we took the evidence-based practice of perioperative airway management in elderly fracture patients as an example and adopted a descriptive phenomenological approach to understand the influencing factors of its sustainability to provide a reference basis for promoting the continuity of evidence-based practice in the clinic.
AIM To explore factors influencing the persistence of evidence-based practice in perioperative airway management in elderly patients with fractures.
METHODS This study was qualitative research. Nine nurses who implemented evidence-based practice in the orthopedic ward of a tertiary comprehensive hospital in Shanghai from September 2023 to October 2023 were selected using purposive sampling as research subjects. Semi-structured interviews were conducted with them, and the data were analyzed using the Colaizzi phenomenological analysis method based on the three dimensions and ten factors of the NHS sustainability model.
RESULTS Three main themes and ten subthemes were identified: Process aspects (benefits to patients, benefits to nurses, lack of follow-up, complex processes); staff aspects (insufficient human resources, inadequate training and education, lack of leadership support); and organizational environment aspects (inadequate infrastructure, poor patient compliance, poor doctor cooperation).
CONCLUSION Human resources, training and education, leadership support, infrastructure, and patient-physician collaboration are important factors influencing the sustainability of evidence-based practice for perioperative airway management in older patients with fractures.
Collapse
Affiliation(s)
- Jia Zeng
- Wuxi School of Medicine, Jiangnan University, Wuxi 214122, Jiangsu Province, China
| | - Jia Zhang
- Department of Nursing, Shanghai Tongren Hospital, Shanghai 200335, China
| | - Rui Li
- Department of Nursing, Shanghai Tongren Hospital, Shanghai 200335, China
| | - Zhi-Heng Guo
- Department of Emergency, Shanghai Tongren Hospital, Shanghai 200335, China
| | - Fang Wu
- Department of Orthopedics, Shanghai Tongren Hospital, Shanghai 200335, China
| | - Si-Meng Wang
- Wuxi School of Medicine, Jiangnan University, Wuxi 214122, Jiangsu Province, China
| | - Hai-Yue Zhang
- Wuxi School of Medicine, Jiangnan University, Wuxi 214122, Jiangsu Province, China
| | - Fei-Hu Qian
- Department of Emergency, Shanghai Tongren Hospital, Shanghai 200335, China
| |
Collapse
|
2
|
Sales Coll M, De Castro R, Ochoa de Echagüen A, Martínez Ibáñez V. Economic Impact of Lean Healthcare Implementation on the Surgical Process. Healthcare (Basel) 2024; 12:512. [PMID: 38470622 PMCID: PMC10930714 DOI: 10.3390/healthcare12050512] [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: 01/14/2024] [Revised: 02/10/2024] [Accepted: 02/15/2024] [Indexed: 03/14/2024] Open
Abstract
OBJECTIVES The objective of this study was to analyse and detail surgical process improvement activities that achieve the highest economic impact. METHODS Over 4 years, a team of technicians and healthcare professionals implemented a set of Lean surgical process improvement projects at Vall d'Hebron University Hospital (VHUH), Barcelona, Spain. Methods employed in the study are common in manufacturing environments and include reducing waiting and changeover time (SMED), reducing first time through, pull, and continuous flow. Projects based on these methods now form part of the daily routine in the surgical process. The economic impact on the hospital's surgical activity budget was analysed. RESULTS Process improvements have led to annual operational savings of over EUR 8.5 million. These improvements include better patient flow, better management of information between healthcare professionals, and improved logistic circuits. CONCLUSIONS The current cultural shift towards process management in large hospitals implies shifting towards results-based healthcare, patient-perceived value (VBHC), and value-added payment. A Lean project implementation process requires long-term stability. The reason a considerable number of projects fail to complete process improvement projects is the difficulty involved in establishing the project and improving management routines. Few studies in the literature have investigated the economic impact of implementing Lean management a posteriori, and even fewer have examined actual cases. In this real case study, changes to surgical block management were initiated from stage zero. After being carefully thought through and designed, changes were carried out and subsequently analysed.
Collapse
Affiliation(s)
| | - Rodolfo De Castro
- Department of Organization, Business Management and Product Design, University of Girona, 17003 Girona, Spain
| | | | | |
Collapse
|
3
|
Kula R, Popela S, Klučka J, Charwátová D, Djakow J, Štourač P. Modern Paediatric Emergency Department: Potential Improvements in Light of New Evidence. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10040741. [PMID: 37189990 DOI: 10.3390/children10040741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 05/17/2023]
Abstract
The increasing attendance of paediatric emergency departments has become a serious health issue. To reduce an elevated burden of medical errors, inevitably caused by a high level of stress exerted on emergency physicians, we propose potential areas for improvement in regular paediatric emergency departments. In an effort to guarantee the demanded quality of care to all incoming patients, the workflow in paediatric emergency departments should be sufficiently optimised. The key component remains to implement one of the validated paediatric triage systems upon the patient's arrival at the emergency department and fast-tracking patients with a low level of risk according to the triage system. To ensure the patient's safety, emergency physicians should follow issued guidelines. Cognitive aids, such as well-designed checklists, posters or flow charts, generally improve physicians' adherence to guidelines and should be available in every paediatric emergency department. To sharpen diagnostic accuracy, the use of ultrasound in a paediatric emergency department, according to ultrasound protocols, should be targeted to answer specific clinical questions. Combining all mentioned improvements might reduce the number of errors linked to overcrowding. The review serves not only as a blueprint for modernising paediatric emergency departments but also as a bin of useful literature which can be suitable in the paediatric emergency field.
Collapse
Affiliation(s)
- Roman Kula
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
- Department of Physiology, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
| | - Stanislav Popela
- Emergency Department, University Hospital Olomouc and Faculty of Medicine, Palacký University, I.P. Pavlova 185/6, 779 00 Olomouc, Czech Republic
- Emergency Medical Service of the South Moravian Region, Kamenice 798, 625 00 Brno, Czech Republic
| | - Jozef Klučka
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
| | - Daniela Charwátová
- Department of Surgery, Vyškov Hospital, Purkyňova 235/36, 682 01 Vyškov, Czech Republic
| | - Jana Djakow
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
- Paediatric Intensive Care Unit, NH Hospital Inc., 268 01 Hořovice, Czech Republic
| | - Petr Štourač
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
| |
Collapse
|
4
|
Rowe A, Knox M. The Impact of the Healthcare Environment on Patient Experience in the Emergency Department: A Systematic Review to Understand the Implications for Patient-Centered Design. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2022; 16:310-329. [PMID: 36541114 PMCID: PMC10133779 DOI: 10.1177/19375867221137097] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background: The emergency department (ED) is a complex, volatile, and limited-resource healthcare setting. Many environmental factors, including high patient volumes, overburdened staff, long waits, and a tense atmosphere, converge in the ED. The objective of this study was to perform a systematic review of extant literature to understand how the ED environment drives patient experience and identify methodological or empirical insights for patient-centered ED design. Methods: We searched eight academic databases (Web of Science, PubMed, Scopus, Medline [Ovid], CINAHL, PyscInfo, Compendex, and IEEE Explore) to identify studies that employed observational (descriptive) or interventional (evaluative) methodology. We performed a co-citation analysis of potentially eligible articles and a qualitative synthesis of findings from studies included in our final sample. Results: Our search yielded 117 records. Of the 35 potentially relevant articles, 18 were published in the last 5 years, and 50% were authored by investigators in the United States. We used 33 articles for a co-citation analysis, revealing three interdisciplinary clusters and promising potential for collaboration across fields. Thirty articles were subjected to a full-text analysis, resulting in the identification of three overarching dimensions linking the ED environment to patient experience. Conclusion: The most commonly identified factors influencing patient experience in the ED included overcrowding and wait times, privacy, and communication; however, existing literature is limited. More research is needed to understand how ED environments configure patient experience and can be improved through design. Particularly, there is little research on participatory interventional strategies in the ED, despite strong evidence suggesting a need for stakeholder participation.
Collapse
Affiliation(s)
- Aidan Rowe
- Department of Art & Design, University of Alberta, Edmonton, Alberta, Canada
- Design x Health Research Innovation Lab (DHRIL), University of Alberta, Edmonton, Alberta, Canada
| | - Michelle Knox
- Design x Health Research Innovation Lab (DHRIL), University of Alberta, Edmonton, Alberta, Canada
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
5
|
SARTINI MARINA, PATRONE CARLOTTA, SPAGNOLO ANNAMARIA, SCHINCA ELISA, OTTRIA GIANLUCA, DUPONT CHIARA, ALESSIO-MAZZOLA MATTIA, BRAGAZZI NICOLALUIGI, CRISTINA MARIALUISA. The management of healthcare-related infections through lean methodology: systematic review and meta-analysis of observational studies. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2022; 63:E464-E475. [PMID: 36415303 PMCID: PMC9648549 DOI: 10.15167/2421-4248/jpmh2022.63.3.2661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/13/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Lean is largely applied to the health sector and on the healthcare-associated infections (HAI). However, a few results on the improvement of the outcome have been reported in literature. The purpose of this study is to analyze if the lean application can reduce the HAI rate. METHODS A comprehensive search was performed on PubMed/Medline, Scopus, CINAHL, Cochrane, Embase, and Google Scholar databases using various combinations of the following keywords: "lean" and "infection". Inclusion criteria were: 1) research articles with quantitative data and relevant information on lean methodology and its impact on healthcare infections; 2) prospective studies. The risk of bias and the study quality was independently assessed by two researchers using the "The National Institutes of Health (NIH) quality assessment tool for before-after (Pre-Post) study with no control group". The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines has been used. 22 studies were included in the present meta-analysis. RESULTS Lean application demonstrated a significant protective role on healthcare-associated infections rate (RR 0.50; 95% C.I.: 0.38-0.66) with significant impact on central line-associated bloodstream infections (CLABSIs) (RR 0.47; 95% C.I.: 0.28-0.82). CONCLUSIONS Lean has a positive impact on the decreasing of HAIs and on the improvement of compliance and satisfaction of the staff.
Collapse
Affiliation(s)
- MARINA SARTINI
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- S.S.D. U.O. Hospital Hygiene, E.O. Ospedali Galliera, Genoa, Italy
| | - CARLOTTA PATRONE
- Department of Directorate, Office Innovation, Development and Lean Application, E.O. Ospedali Galliera, Genoa, Italy
| | - ANNA MARIA SPAGNOLO
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- S.S.D. U.O. Hospital Hygiene, E.O. Ospedali Galliera, Genoa, Italy
| | - ELISA SCHINCA
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- S.S.D. U.O. Hospital Hygiene, E.O. Ospedali Galliera, Genoa, Italy
| | - GIANLUCA OTTRIA
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- S.S.D. U.O. Hospital Hygiene, E.O. Ospedali Galliera, Genoa, Italy
| | - CHIARA DUPONT
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | | | - NICOLA LUIGI BRAGAZZI
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON, Canada
| | - MARIA LUISA CRISTINA
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- S.S.D. U.O. Hospital Hygiene, E.O. Ospedali Galliera, Genoa, Italy
- Correspondence: Maria-Luisa Cristina, Dep. Health Sciences, University of Genoa, Via A. Pastore 1 – 16132 Genova. Phone +39 010 3538883 - E-mail ;
| |
Collapse
|
6
|
Quality Improvement: Implementing Nurse Standard Work in Emergency Department Fast-Track Area to Reduce Patient Length of Stay. J Emerg Nurs 2022; 48:666-677. [PMID: 36075769 PMCID: PMC9444840 DOI: 10.1016/j.jen.2022.07.009] [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: 12/03/2021] [Revised: 07/08/2022] [Accepted: 07/23/2022] [Indexed: 11/21/2022]
Abstract
Introduction The average length of stay of a fast-track area of a large urban hospital was excessively long, which affected the patient experience and the rate at which patients left without being seen. One approach to reducing average length of stay is to create nurse standard work. Nurse standard work was a defined set of process and procedures that reduce variability within a nurse’s workflow. Methods Nurse standard work was created by a team of nurses assisted by management engineering using lean methodology and A3 problem solving. Data were gathered about average length of stay and left without being seen for patients in the emergency department fast-track area of an urban emergency department from October 2018 to June 2020. This period includes 5 months before the intervention start, 4 months during nurse standard work implementation, 9 months using nurse standard work before the unit was repurposed during COVID-19, and 3 months during COVID-19. Results Nurse standard work helped reduce average length of stay in the emergency department fast-track area from 205 minutes before project initiation to 150.4 minutes in the 7 months after implementing nurse standard work. The time spent walking for supplies was reduced from 422 and 272 seconds before nurse standard work to 25 and 30 seconds for the nurse technician and nurse, respectively, after nurse standard work. Left without being seen was decreased from 4.7% in October of 2018 to 0.7% by March of 2020. Discussion Nurse standard work reduced the amount of time that nurses spent performing support tasks and reduced delays in providing patient care, which then allowed more time for nurses to interact directly with patients. Nurse standard work provides a clear task sequence that eliminates delays in treating patients, but it also allows for fast identification of delays that do occur and simplifies problem solving to eliminate reoccurrence of delays. Therefore, nurse standard work is an essential component of efforts to reduce patient average length of stay in health care processes and reduce left without being seen to the national standard of less than 2%.
Collapse
|
7
|
Leite H. The role of lean in healthcare during COVID-19 pandemic. INTERNATIONAL JOURNAL OF QUALITY & RELIABILITY MANAGEMENT 2022. [DOI: 10.1108/ijqrm-10-2021-0353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe impact of the COVID-19 pandemic on healthcare operations has raised questions about the applicability and capacity of the lean approach to respond to critical events. Thus, with a dearth of studies addressing this issue, this study aims to understand the role of lean in healthcare operations under the disruptive impact of the COVID-19 pandemic.Design/methodology/approachDrawing on a case study carried out in an emergency department in Brazil during the COVID-19 outbreak, the author presents results from semi-structured interviews and document analysis.FindingsThe results show three prominent themes that respond to this study's purpose: lean applicability during the pandemic, lean challenges during the pandemic and the pandemic impact on the lean processes. Furthermore, the study underscores that lean is not the panacea to operational problems caused by the pandemic in healthcare organisations, but it eases the impact on their operations. Finally, this study contributes to the discipline of operations management and highlights the need to rethink lean applications during disruptive events, focusing on flexibility, adaptability and patients' needs.Research limitations/implicationsThe literature addressing the pandemic impact on healthcare operations is still new and emerging; therefore, it is possible that some of the studies that are under review and could contribute to this study were not considered.Practical implicationsThe study provides a better understanding of the lessons learned from the real-world experiences gained during the pandemic, helping managers to make informed decisions when developing contingency plans to improve healthcare readiness and responsiveness under crisis conditions (e.g. untenable demand and constrained capacity).Originality/valueGiven the contemporary nature of this pandemic, only few emerging studies addressing the impact of the pandemic on lean healthcare operations are available and scholars are calling for more empirical studies. Furthermore, there is an increasing criticism and scepticism about the applicability of lean in healthcare during a pandemic. Thus, this research both provides original contributions by responding to scholars' calls for novel research in this area and further contributes towards filling the void in the literature.
Collapse
|
8
|
Yadav AK, Kumar D. A fuzzy decision framework of lean-agile-green (LAG) practices for sustainable vaccine supply chain. INTERNATIONAL JOURNAL OF PRODUCTIVITY AND PERFORMANCE MANAGEMENT 2022. [DOI: 10.1108/ijppm-10-2021-0590] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PurposeThe already-strained vaccine supply chain (VSC) of the expanded program for immunization (EPI) require a more robust and structured distribution network for pandemic/outbreak vaccination due to huge volume demand and time constraint. In this paper, a lean-agile-green (LAG) practices approach is proposed to improve the operational, economic and environmental efficiency of the VSC.Design/methodology/approachA fuzzy decision framework of importance performance analysis (IPA)–analytical hierarchy process (AHP)–technique for order for preference by similarity in ideal solution (TOPSIS) has been presented in this paper to prioritize the LAG practices on the basis of the influence on performance indicators. Sensitivity analysis is carried out to check the robustness of the presented model.FindingsThe derived result indicates that sustainable packaging, coordination among supply chain stakeholders and cold chain technology improvement are among the top practices affecting most of the performance parameters of VSC. The sensitivity analysis reveals that the priority of practices is highly dependent on the weightage of performance indicators.Practical implicationsThis study's finding will help policymakers reframe strategies for sustainable VSC (SVSC) by including new management practices that can handle regular immunization programs as well as emergency mass vaccination.Originality/valueTo the best of the authors' knowledge, this is the first study that proposes the LAG framework for SVSC. The IPA–Fuzzy AHP (FAHP)–Fuzyy TOPSIS (FTOPSIS) is also a novel combination in decision-making.
Collapse
|
9
|
Teeling SP, Dewing J, Baldie D. A Realist Inquiry to Identify the Contribution of Lean Six Sigma to Person-Centred Care and Cultures. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910427. [PMID: 34639727 PMCID: PMC8507723 DOI: 10.3390/ijerph181910427] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/30/2021] [Accepted: 10/01/2021] [Indexed: 11/16/2022]
Abstract
A lack of fidelity to Lean Six Sigma's (LSS) philosophical roots can create division between person-centred approaches to transforming care experiences and services, and system wide quality improvement methods focused solely on efficiency and clinical outcomes. There is little research into, and a poor understanding of, the mechanisms and processes through which LSS education influences healthcare staffs' person-centred practice. This realist inquiry asks 'whether, to what extent and in what ways, LSS in healthcare contributes to person-centred care and cultures'. Realist review identified three potential Context, Mechanism, Outcome configurations (CMOcs) explaining how LSS influenced practice, relating to staff, patients, and organisational influences. Realist evaluation was used to explore the CMOc relating to staff, showing how they interacted with a LSS education Programme (the intervention) with CMOc adjudication by the research team and study participants to determine whether, to what extent, and in what ways it influenced person-centred cultures. Three more focused CMOcs emerged from the adjudication of the CMOc relating to staff, and these were aligned to previously identified synergies and divergences between participants' LSS practice and person-centred cultures. This enabled us to understand the contribution of LSS to person-centred care and cultures that contribute to the evidence base on the study of quality improvement beyond intervention effectiveness alone.
Collapse
Affiliation(s)
- Seán Paul Teeling
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems, School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin D04 V1W8, Ireland
- Mater Lean Academy, Mater Misericordiae University Hospital, Eccles Street, Dublin D07 R2WY, Ireland
- Centre for Person-Centred Practice Research Division of Nursing, School of Health Sciences, Queen Margaret University Drive, Queen Margaret University, Musselburgh, East Lothian, Scotland EH21 6UU, UK; (J.D.); (D.B.)
- Correspondence:
| | - Jan Dewing
- Centre for Person-Centred Practice Research Division of Nursing, School of Health Sciences, Queen Margaret University Drive, Queen Margaret University, Musselburgh, East Lothian, Scotland EH21 6UU, UK; (J.D.); (D.B.)
| | - Deborah Baldie
- Centre for Person-Centred Practice Research Division of Nursing, School of Health Sciences, Queen Margaret University Drive, Queen Margaret University, Musselburgh, East Lothian, Scotland EH21 6UU, UK; (J.D.); (D.B.)
- Nursing and Midwifery Directorate, NHS Grampian, Scotland AB25 2ZN, UK
| |
Collapse
|
10
|
Tiso A, Crema M, Verbano C. A framework to guide the implementation of lean management in emergency department. J Health Organ Manag 2021; 35:315-337. [PMID: 34558251 PMCID: PMC9136873 DOI: 10.1108/jhom-01-2021-0035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE The paper aims at enriching the knowledge of the application of lean management (LM) in emergency department (ED), structuring the methodology for implementing LM projects and summarizing the relevant dimensions of LM adoption in ED. DESIGN/METHODOLOGY/APPROACH In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, a systematic literature review has been performed, extracting a database of 34 papers. To answer the research purpose, a descriptive and content analyses have been carried out. FINDINGS The descriptive analysis demonstrates that the dealt topic is worldwide emerging and multidisciplinary as it arouses interest by medical and engineering communities. Despite the heterogeneity in the adopted methodology, a framework can be grasped from the literature review. It points out the phases and activities, the tools and techniques and the enablers to be considered for guiding the developing of LM project in ED. ORIGINALITY/VALUE This paper provides a comprehensive overview on how to adopt LM in ED, contributing to fill in the gap emerged in the literature. From a practical perspective, this paper provides healthcare managers with a synthesis of the best managerial practices and guidelines in developing a LM project in ED.
Collapse
Affiliation(s)
- Anna Tiso
- Department of Management and Engineering, University of Padova, Padova, Italy
| | - Maria Crema
- Azienda ULSS N 2 Marca Trevigiana, Treviso, Italy
| | - Chiara Verbano
- Department of Management and Engineering, University of Padova, Padova, Italy
| |
Collapse
|
11
|
Slyngstad L. The Contribution of Variable Control Charts to Quality Improvement in Healthcare: A Literature Review. J Healthc Leadersh 2021; 13:221-230. [PMID: 34531694 PMCID: PMC8439712 DOI: 10.2147/jhl.s319169] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/31/2021] [Indexed: 11/23/2022] Open
Abstract
Objective To conduct a literature review to determine where and how variable control charts have contributed to quality improvement in healthcare. Methods A targeted literature search of the ABI/INFORM Global, Science Direct, Medline and Google Scholar databases was conducted, which yielded 6875 papers. Screening articles on the basis of title and abstract resulted in references to 163 articles, leading to the identification of 29 articles published between 1992 and 2019 that met the inclusion criteria. Common themes, variables and units of analysis were then analyzed. Results Variable control charts have been applied in 11 different healthcare contexts, using 17 different variables, at various levels within healthcare organizations. The main reason for applying variable control charts is to demonstrate a process change, usually following a specific change or quality intervention. The study identified various limitations and benefits of applying variable control charts. The charts are visually easy to understand for both management and employees, but they are limited by their requirement for potentially complex and resource-intensive data collection. Conclusion Variable control charts contribute to quality improvement in healthcare by enabling visualization and monitoring of variations and changes in healthcare processes. The methodology has been most frequently used to demonstrate process shifts after quality interventions. There still is a great potential for more studies applying variable control charts.
Collapse
|
12
|
Rosa A, Marolla G, Lega F, Manfredi F. Lean adoption in hospitals: the role of contextual factors and introduction strategy. BMC Health Serv Res 2021; 21:889. [PMID: 34454500 PMCID: PMC8403367 DOI: 10.1186/s12913-021-06885-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 08/09/2021] [Indexed: 11/15/2022] Open
Abstract
Background In the scientific literature, many studies describe the application of lean methodology in the hospital setting. Most of the articles focus on the results rather than on the approach adopted to introduce the lean methodology. In the absence of a clear view of the context and the introduction strategy, the first steps of the implementation process can take on an empirical, trial and error profile. Such implementation is time-consuming and resource-intensive and affects the adoption of the model at the organizational level. This research aims to outline the role contextual factors and introduction strategy play in supporting the operators introducing lean methodology in a hospital setting. Methodology The methodology is revealed in a case study of an important hospital in Southern Italy, where lean has been successfully introduced through a pilot project in the pathway of cancer patients. The originality of the research is seen in the detailed description of the contextual elements and the introduction strategy. Results The results show significant process improvements and highlight the spontaneous dissemination of the culture of change in the organization and the streamlined adoption at the micro level. Conclusion The case study shows the importance of the lean introduction strategy and contextual factors for successful lean implementation. Furthermore, it shows how both factors influence each other, underlining the dynamism of the organizational system. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06885-4.
Collapse
Affiliation(s)
- Angelo Rosa
- Department of Management Studies, LUM University, S.S. 100 Km, 70010, Casamassima, Italy
| | - Giuliano Marolla
- Department of Management Studies, LUM University, S.S. 100 Km, 70010, Casamassima, Italy.
| | - Federico Lega
- Center in Health Administration, and Center for Applied Health Economics and Management of IRCCS Galeazzi, University of Milan, Via Giacomo Venezian, 1, 20133, Milan, Italy
| | - Francesco Manfredi
- Department of Management Studies, LUM University, S.S. 100 Km, 70010, Casamassima, Italy
| |
Collapse
|
13
|
Big Data-Enabled Solutions Framework to Overcoming the Barriers to Circular Economy Initiatives in Healthcare Sector. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147513. [PMID: 34299964 PMCID: PMC8305369 DOI: 10.3390/ijerph18147513] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/07/2021] [Accepted: 07/09/2021] [Indexed: 11/18/2022]
Abstract
Ever-changing conditions and emerging new challenges affect the ability of the healthcare sector to survive with the current system, and to maintain its processes effectively. In the healthcare sector, the conservation of the natural resources is being obstructed by insufficient infrastructure for managing residual waste resulting from single-use medical materials, increased energy use, and its environmental burden. In this context, circularity and sustainability concepts have become essential in healthcare to meliorate the sector’s negative impacts on the environment. The main aim of this study is to identify the barriers related to circular economy (CE) in the healthcare sector, apply big data analytics in healthcare, and provide solutions to these barriers. The contribution of this research is the detailed examination of the current healthcare literature about CE adaptation, and a proposal for a big data-enabled solutions framework to barriers to circularity, using fuzzy best-worst Method (BWM) and fuzzy VIKOR. Based on the findings, managerial, policy, and theoretical implementations are recommended to support sustainable development initiatives in the healthcare sector.
Collapse
|
14
|
Lanza-León P, Sanchez-Ruiz L, Cantarero-Prieto D. Kanban system applications in healthcare services: A literature review. Int J Health Plann Manage 2021; 36:2062-2078. [PMID: 34235781 DOI: 10.1002/hpm.3276] [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: 06/22/2020] [Revised: 06/03/2021] [Accepted: 06/29/2021] [Indexed: 11/06/2022] Open
Abstract
Lean Management method has been applied in several fields before its implementation in healthcare area. Among the different techniques associated with Lean, in this paper, we are focused on Kanban system, which is a method that presents several benefits such as inventory holding reduction or improvement of the employees' satisfaction. Our main objective is to carry out a literature review focused on Kanban methodology applied to health care. In this sense, this study can serve as a script to improve hospital management in pandemic periods, such as the one currently lived on COVID-19. We carry out a literature review searching in four different databases. We combine several terms to achieve our objective. We identify several articles which describe Kanban methodology applied to health field. More specifically, we present in what areas (nursing or pharmacy, among others) this method has been applied. In addition, we show all the barriers as well as benefits caused by the implementation of this system. There are a few studies focused on analysing how Kanban is applied to health care. Therefore, we can affirm that this topic is still recent.
Collapse
Affiliation(s)
- Paloma Lanza-León
- Health Economics and Health Services Management Research Group, Santander, Spain.,Department of Economics, University of Cantabria, Santander, Spain
| | - Lidia Sanchez-Ruiz
- Health Economics and Health Services Management Research Group, Santander, Spain.,Department of Business and Management, University of Cantabria, Santander, Spain
| | - David Cantarero-Prieto
- Health Economics and Health Services Management Research Group, Santander, Spain.,Department of Economics, University of Cantabria, Santander, Spain
| |
Collapse
|
15
|
Souza DL, Korzenowski AL, Alvarado MM, Sperafico JH, Ackermann AEF, Mareth T, Scavarda AJ. A Systematic Review on Lean Applications' in Emergency Departments. Healthcare (Basel) 2021; 9:healthcare9060763. [PMID: 34205337 PMCID: PMC8235665 DOI: 10.3390/healthcare9060763] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/05/2021] [Accepted: 06/12/2021] [Indexed: 11/18/2022] Open
Abstract
This article presents the state of the art of Lean principles applied in Emergency Departments through a systematic literature review. Our article extends previous work found in the literature to respond to the following questions: (i) What research problems in emergency departments can Lean principles help overcome? (ii) What Lean approaches and tools are used most often in this environment? (iii) What are the results and benefits obtained by these practices? and (iv) What research opportunities appear as gaps in the current state of the art on the subject? A six-step systematic review was performed following the guidance of the PRISMA method. The review analysis identified six main research problems where Lean was applied in Emergency Departments: (i) High Waiting Time and High Length of Hospital Stay; (ii) Health Safety; (iii) Process redesign; (iv) Management and Lessons Learned; (v) High Patient Flow; (vi) Cost Analysis. The six research problems’ main approaches identified were Lean Thinking, Multidisciplinary, Statistics, and Six Sigma. The leading Lean tools and methodologies were VSM, Teamwork, DMAIC, and Kaizen. The main benefits of applying Lean Principles were (a) reductions in waiting time, costs, length of hospital stay, patient flow, and procedure times; and (b) improvements in patient satisfaction, efficiency, productivity, standardization, relationships, safety, quality, and cost savings. Multidisciplinary integration of managers and work teams often yields good results. Finally, this study identifies knowledge gaps and new opportunities to study Lean best practices in healthcare organizations.
Collapse
Affiliation(s)
- Davenilcio Luiz Souza
- Industrial & Systems Engineering Department, Polytechnic School, University of Vale do Rio dos Sinos, São Leopoldo 93022-750, RS, Brazil; (D.L.S.); (J.H.S.); (A.E.F.A.)
| | - André Luis Korzenowski
- Industrial & Systems Engineering Department, Polytechnic School, University of Vale do Rio dos Sinos, São Leopoldo 93022-750, RS, Brazil; (D.L.S.); (J.H.S.); (A.E.F.A.)
- Accounting Department, School of Management and Business, University of Vale do Rio dos Sinos, Porto Alegre 91330-002, RS, Brazil;
- Correspondence: ; Tel.: +55-51-99163-6371
| | - Michelle McGaha Alvarado
- Industrial & Systems Engineering Department, Herbert Wertheim College of Engineering, University of Florida, Gainesville, FL 32611, USA;
| | - João Henrique Sperafico
- Industrial & Systems Engineering Department, Polytechnic School, University of Vale do Rio dos Sinos, São Leopoldo 93022-750, RS, Brazil; (D.L.S.); (J.H.S.); (A.E.F.A.)
| | - Andres Eberhard Friedl Ackermann
- Industrial & Systems Engineering Department, Polytechnic School, University of Vale do Rio dos Sinos, São Leopoldo 93022-750, RS, Brazil; (D.L.S.); (J.H.S.); (A.E.F.A.)
| | - Taciana Mareth
- Accounting Department, School of Management and Business, University of Vale do Rio dos Sinos, Porto Alegre 91330-002, RS, Brazil;
| | - Annibal José Scavarda
- Department of Production Engineering, Center for Exact Sciences and Technology, Federal University of the State of Rio de Janeiro, Rio de Janeiro 22290-255, RJ, Brazil;
| |
Collapse
|
16
|
The impact of lean management on frontline healthcare professionals: a scoping review of the literature. BMC Health Serv Res 2021; 21:383. [PMID: 33902552 PMCID: PMC8074224 DOI: 10.1186/s12913-021-06344-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 04/03/2021] [Indexed: 12/20/2022] Open
Abstract
Background Lean management practices are increasingly used in hospitals. However, their impacts on staff have not been systematically synthesised. This scoping review aims to synthesise the evidence on the effects of Lean Management practices on frontline healthcare professionals. Methods A search was conducted in February 2020 on multiple databases to identify relevant sources. Studies had to satisfy the following inclusion criteria to be considered: published in English or French, peer-reviewed, empirical, studied the use of Lean in a healthcare setting and focused on its impacts on frontline workers. The studies included were heterogeneous in terms of participants. Findings were coded and classified using a thematic analysis. The quality and methodological rigour of the reviewed articles were assessed to establish a level of confidence in their findings. Results Of 998 identified articles, 17 were included in the review. The findings were coded into four themes: (1) Morale, motivation and job satisfaction (n = 9, 2) work intensification, job strain, anxiety, stress and dehumanisation (n = 7, 3) teamwork, communication and coordination (n = 6); and (4) learning, innovation and personal development (n = 3). Overall, the articles reported positive (n = 11), negative (n = 3) and mixed (n = 3) impacts of Lean on frontline healthcare professionals. Conclusion This review is the first to synthesise and highlight the gaps in the existing literature examining the impacts of Lean on frontline health professionals. The review revealed a range of both positive, negative and mixed effects, and points to the need for more empirical research to identify the underlying reasons leading to these outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06344-0.
Collapse
|
17
|
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.
Collapse
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
| |
Collapse
|
18
|
Alkaabi M, Simsekler MCE, Jayaraman R, Al Kaf A, Ghalib H, Quraini D, Ellahham S, Tuzcu EM, Demirli K. Evaluation of System Modelling Techniques for Waste Identification in Lean Healthcare Applications. Risk Manag Healthc Policy 2021; 13:3235-3243. [PMID: 33447104 PMCID: PMC7802016 DOI: 10.2147/rmhp.s283189] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 10/30/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Waste identification plays a vital role in lean healthcare applications. While the value stream map (VSM) is among the most commonly used tools for waste identification, it may be limited to visualize the behaviour of dynamic and complex healthcare systems. To address this limitation, system modelling techniques (SMTs) can be used to provide a comprehensive picture of various system-wide wastes. However, there is a lack of evidence in the current literature about the potential contribution of SMTs for waste identification in healthcare processes. Methods This study evaluates the usability and utility of six types of SMTs along with the VSM. For the evaluation, interview-based questionnaires were conducted with twelve stakeholders from the outpatient clinic at the Heart and Vascular Institute at Cleveland Clinic Abu Dhabi. Results VSM was found to be the most useful diagram in waste identification in general. However, some SMTs that represent the system behaviour outperformed the VSM in identifying particular waste types, e.g., communication diagram in identifying over-processing waste and flow diagram in identifying transportation waste. Conclusion As behavioural SMTs and VSM have unique strengths in identifying particular waste types, the use of multiple diagrams is recommended for a comprehensive waste identification in lean. However, limited resources and time, as well as limited experience of stakeholders with SMTs, may still present obstacles for their potential contribution in lean healthcare applications.
Collapse
Affiliation(s)
- Maitha Alkaabi
- Department of Industrial and Systems Engineering, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Mecit Can Emre Simsekler
- Department of Industrial and Systems Engineering, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Raja Jayaraman
- Department of Industrial and Systems Engineering, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Abdulqader Al Kaf
- Department of Industrial and Systems Engineering, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Hussam Ghalib
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Dima Quraini
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Samer Ellahham
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - E Murat Tuzcu
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Kudret Demirli
- Department of Mechanical, Industrial and Aerospace Engineering, Concordia University, Montreal, Canada
| |
Collapse
|
19
|
Leite H. The impact of non-urgent patients in emergency departments' operations. INTERNATIONAL JOURNAL OF QUALITY & RELIABILITY MANAGEMENT 2020. [DOI: 10.1108/ijqrm-01-2020-0016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeGlobally, the presence of non-urgent patients in emergency departments (EDs) is considered one of the main reasons for creating excessive waiting times and overcrowding in units. This paper aims to understand the impact of non-urgent patients in EDs' operations.Design/methodology/approachThis study is based on qualitative case studies conducted within two Brazilian EDs, and uses interviews and observations to access the data.FindingsFrom a thematic analysis, three key themes emerged: characteristics of non-urgent demands in EDs, negative aspects of non-urgent patients in EDs, and the impact of the healthcare system model on EDs. These themes bring to light the impact that non-urgent patients have in EDs' operations, and provide theoretical and practical implications.Research limitations/implicationsThe limitation of this work is bound by the understanding of the non-urgent demands in EDs. Therefore, a benchmarking approach (investigating state-of-the-art practices to avoid such impact) was not applied but was suggested for future research instead.Practical implicationsThe research provides significant contributions to practitioners and policymakers, aiding future discussions to improve healthcare coverage and performance.Social implicationsThe research provides significant contributions for managers and policymakers, aiding future discussions to improve healthcare. For instance, the use of well-known techniques (e.g. lean, six sigma) are discussed and suggested to enhance healthcare capacity and performance. Furthermore, the policymakers are called upon to evaluate the healthcare access and provide regulations that involve innovative approaches to widen healthcare access.Originality/valueBased upon empirical data, this research extends the discussions related to non-urgent patient in EDs and is not limited merely to descriptive analysis, but by providing practical propositions and discussions related to the impact of these patients' presence in EDs' operations. Finally, the research provides a range of suggestions for future research related to the EDs' operational performance.
Collapse
|
20
|
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.
Collapse
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;
| |
Collapse
|
21
|
Cowie J, Nicoll A, Dimova ED, Campbell P, Duncan EA. The barriers and facilitators influencing the sustainability of hospital-based interventions: a systematic review. BMC Health Serv Res 2020; 20:588. [PMID: 32594912 PMCID: PMC7321537 DOI: 10.1186/s12913-020-05434-9] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 06/15/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Identifying factors that influence sustained implementation of hospital-based interventions is key to ensuring evidence-based best practice is maintained across the NHS. This study aimed to identify, appraise and synthesise the barriers and facilitators that influenced the delivery of sustained healthcare interventions in a hospital-based setting. METHODS A systematic review reported in accordance with PRISMA. Eight electronic databases were reviewed in addition to a hand search of Implementation Science journal and reference lists of included articles. Two reviewers were used to screen potential abstracts and full text papers against a selection criteria. Study quality was also independently assessed by two reviewers. Barriers and facilitators were extracted and mapped to a consolidated sustainability framework. RESULTS Our searching identified 154,757 records. We screened 14,626 abstracts and retrieved 431 full text papers, of which 32 studies met the selection criteria. The majority of studies employed a qualitative design (23/32) and were conducted in the UK (8/32) and the USA (8/32). Interventions or programmes were all multicomponent, with the majority aimed at improving the quality of patient care and/ or safety (22/32). Sustainability was inconsistently reported across 30 studies. Barriers and facilitators were reported in all studies. The key facilitators included a clear accountability of roles and responsibilities (23/32); ensuring the availability of strong leadership and champions advocating the use of the intervention (22/32), and provision of adequate support available at an organisational level (21/32). The most frequently reported barrier to sustainability was inadequate staff resourcing (15/32). Our review also identified the importance of inwards spread and development of the initiative over time, as well as the unpredictability of sustainability and the need for multifaceted approaches. CONCLUSIONS This review has important implications for practice and research as it increases understanding of the factors that faciliate and hinder intervention sustainability. It also highlights the need for more consistent and complete reporting of sustainability to ensure that lessons learned can be of direct benefit to future implementation of interventions. TRIAL REGISTRATION The review is registered on PROSPERO ( CRD42017081992 ).
Collapse
Affiliation(s)
- Julie Cowie
- Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP RU), Glasgow Caledonian University, Govan Mbeki Building, Cowcaddens Road, Glasgow, G4 0BX, Scotland.
| | - Avril Nicoll
- Health Services Research Unit, University of Aberdeen, 2nd Floor, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, Scotland
| | - Elena D Dimova
- Department of Nursing and Health, School of Life Sciences, Glasgow Caledonian University, Govan Mbeki Building, Cowcaddens Road, Glasgow, G4 0BX, Scotland
| | - Pauline Campbell
- Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP RU), Glasgow Caledonian University, Govan Mbeki Building, Cowcaddens Road, Glasgow, G4 0BX, Scotland
| | - Edward A Duncan
- Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP RU), Unit 13 Scion House, University of Stirling Innovation Park, Stirling, FK9 4NF, Scotland
| |
Collapse
|
22
|
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.
Collapse
|
23
|
Ortíz-Barrios MA, Alfaro-Saíz JJ. Methodological Approaches to Support Process Improvement in Emergency Departments: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082664. [PMID: 32294985 PMCID: PMC7216091 DOI: 10.3390/ijerph17082664] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/22/2020] [Accepted: 04/03/2020] [Indexed: 02/07/2023]
Abstract
The most commonly used techniques for addressing each Emergency Department (ED) problem (overcrowding, prolonged waiting time, extended length of stay, excessive patient flow time, and high left-without-being-seen (LWBS) rates) were specified to provide healthcare managers and researchers with a useful framework for effectively solving these operational deficiencies. Finally, we identified the existing research tendencies and highlighted opportunities for future work. We implemented the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology to undertake a review including scholarly articles published between April 1993 and October 2019. The selected papers were categorized considering the leading ED problems and publication year. Two hundred and three (203) papers distributed in 120 journals were found to meet the inclusion criteria. Furthermore, computer simulation and lean manufacturing were concluded to be the most prominent approaches for addressing the leading operational problems in EDs. In future interventions, ED administrators and researchers are widely advised to combine Operations Research (OR) methods, quality-based techniques, and data-driven approaches for upgrading the performance of EDs. On a different tack, more interventions are required for tackling overcrowding and high left-without-being-seen rates.
Collapse
Affiliation(s)
- Miguel Angel Ortíz-Barrios
- Department of Industrial Management, Agroindustry and Operations, Universidad de la Costa CUC, Barranquilla 081001, Colombia
- Correspondence: ; Tel.: +57-3007239699
| | - Juan-José Alfaro-Saíz
- Research Centre on Production Management and Engineering, Universitat Politècnica de València, 46022 Valencia, Spain;
| |
Collapse
|
24
|
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.
Collapse
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
| |
Collapse
|
25
|
McNamara M, Teeling SP. Developing a university-accredited Lean Six Sigma curriculum to overcome system blindness. Int J Qual Health Care 2019; 31:3-5. [PMID: 31867665 PMCID: PMC6926382 DOI: 10.1093/intqhc/mzz074] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 05/31/2019] [Accepted: 07/01/2019] [Indexed: 12/28/2022] Open
Abstract
This paper discusses the development of a Lean Six Sigma (LSS) postgraduate education programme that has enabled the delivery of over 90 quality improvement projects led by its graduates across 50 healthcare organizations in Ireland. A key success factor in embedding and sustaining LSS in these organizations was the accreditation by a major, national, research-intensive university of the LSS education programme from which the students graduated. To ensure the programme's approval by the university it was necessary to contextualize LSS within established conceptual frameworks. This helped counter misconceptions that what was proposed was technical training in tools and techniques to provide quick fixes for routine healthcare process issues. Two related conceptual frameworks were selected to frame the curriculum: Senge's Fifth Discipline and Deming's System of Profound Knowledge. This paper focuses on how a central element of both frameworks, systems thinking or appreciation for a system, was enacted in the curriculum using Oshry's work on system blindness. Showing how systems thinking was conceptualized in the curriculum established the legitimacy and credibility of the programme within academia. This led to the approval of the first university-accredited graduate programme in LSS for healthcare in Ireland.
Collapse
Affiliation(s)
- Martin McNamara
- UCD School of Nursing, Midwifery and Health Systems, College of Health and Agricultural Sciences, Dublin 4, Ireland
| | - SeÁn Paul Teeling
- UCD School of Nursing, Midwifery and Health Systems, College of Health and Agricultural Sciences, Dublin 4, Ireland
- Mater Lean Academy, Mater Misericordiae University Hospital, Eccles St., Dublin 7, Ireland
| |
Collapse
|
26
|
Beyranvand T, Aryankhesal A, Aghaei Hashjin A. Quality improvement in hospitals' surgery-related processes: A systematic review. Med J Islam Repub Iran 2019; 33:129. [PMID: 32280635 PMCID: PMC7137843 DOI: 10.34171/mjiri.33.129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Indexed: 11/23/2022] Open
Abstract
Background: There is a growing global movement toward quality and safety in healthcare and quality improvement (QI) in general surgery. The fundamentals of QI begin with an understanding of the underlying theoretical framework. This study aims to provide an overview of the existing QI models and frameworks for general surgery. Methods: In this systematic review, published literature from January 2007 until September 2018 were retrieved from PubMed, Scopus, Web of Science and Embase databases, and Google Scholar using the MeSH terms related to QI and surgery. In total, 25 fulltext articles were finally included, and data extraction was based on research objectives. Results: Nine models were identified for QI in general surgery. These models were categorized into two main groups: (i) conceptual models or frameworks designed for QI in industry and applied in surgery, and (ii) those designed specifically for QI in surgery. Identified QI models were more used for improving postoperative processes and pre-hospital trauma care, identifying causes of prolonged periods of stay and lowering LOS index, improving surgical antimicrobial prophylaxis and antibiotics administrating during surgery process, reducing and controlling infections, reducing complications, reducing mortality and morbidity, reducing waiting times and start time delays, reducing variability and improving surgical clinic experience, reducing costs, improving operating room efficiency by removing processes that add no value, and lowering per-capita costs. Conclusion: According to the findings of this study, there are different models and frameworks with different aspects and dimensions for QI in surgery, which is recommended to use either of these models alone or with each other for specific circumstances. The use of these models in surgery is increasing, and it is recommended that these models could be used according to their functions in cases such as reducing the unnecessary use of resources, increasing the satisfaction of patients and their families with health care and improving the efficiency, safety and quality of healthcare in the surgical departments.
Collapse
Affiliation(s)
- Tina Beyranvand
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Aidin Aryankhesal
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Asgar Aghaei Hashjin
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
27
|
Flynn R, Rotter T, Hartfield D, Newton AS, Scott SD. A realist evaluation to identify contexts and mechanisms that enabled and hindered implementation and had an effect on sustainability of a lean intervention in pediatric healthcare. BMC Health Serv Res 2019; 19:912. [PMID: 31783853 PMCID: PMC6884784 DOI: 10.1186/s12913-019-4744-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 11/14/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2012, the Saskatchewan Ministry for Health mandated a system-wide Lean transformation. Research has been conducted on the implementation processes of this system-wide Lean implementation. However, no research has been done on the sustainability of these Lean efforts. We conducted a realist evaluation on the sustainability of Lean in pediatric healthcare. We used the context (C) + mechanism (M) = outcome (O) configurations (CMOcs) heuristic to explain under what contexts, for whom, how and why Lean efforts are sustained or not sustained in pediatric healthcare. METHODS We employed a case study research design. Guided by a realist evaluation framework, we conducted qualitative realist interviews with various stakeholder groups across four pediatric hospital units 'cases' at one acute hospital. Interview data was analyzed using an integrated approach of CMOc categorization coding, CMOc connecting and pattern matching. RESULTS We conducted thirty-two interviews across the four cases. Five CMOcs emerged from our realist interview data. These configurations illustrated a 'ripple-effect' from implementation outcomes to contexts for sustainability. Sense-making and staff engagement were prominent mechanisms to the sustainment of Lean efforts. Failure to trigger these mechanisms resulted in resistance. The implementation approach used influenced mechanisms and outcomes for sustainability, more so than Lean itself. Specifically, the language, messaging and training approaches used triggered mechanisms of innovation fatigue, poor 'sense-making' and a lack of engagement for frontline staff. The mandated, top-down, externally led nature of implementation and lack of customization to context served as potential pitfalls. Overall, there was variation between leadership and frontline staff's perceptions on how embedded Lean was in their contexts, and the degree to which participants supported Lean sustainability. CONCLUSIONS This research illuminates important contextual factors and mechanisms to the process of Lean sustainment that can be applicable to those implementing systems changes. Future work is needed to continue to develop the science on the sustainability of interventions for healthcare improvement.
Collapse
Affiliation(s)
- Rachel Flynn
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada.
| | - Thomas Rotter
- Healthcare Quality Programs, Queen's University School of Nursing, Kingston, Ontario, K7L 3N6, Canada
| | - Dawn Hartfield
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Amanda S Newton
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Shannon D Scott
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| |
Collapse
|
28
|
Perros I, Yan X, Jones JB, Sun J, Stewart WF. Using the PARAFAC2 tensor factorization on EHR audit data to understand PCP desktop work. J Biomed Inform 2019; 101:103312. [PMID: 31627022 DOI: 10.1016/j.jbi.2019.103312] [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] [Received: 03/13/2019] [Revised: 10/08/2019] [Accepted: 10/13/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Activity or audit log data are required for EHR privacy and security management but may also be useful for understanding desktop workflow. OBJECTIVE We determined if the EHR audit log file, a rich source of complex time-stamped data on desktop activities, could be processed to derive primary care provider (PCP) level workflow measures. METHODS We analyzed audit log data on 876 PCPs across 17,455 ambulatory care encounters that generated 578,394 time-stamped records. Each individual record represents a user interaction (e.g., point and click) that reflects all or part of a specific activity (e.g., order entry access). No dictionary exists to define how to combine clusters of sequential audit log records to represent identifiable PCP tasks. We determined if PARAFAC2 tensor factorization could: (1) learn to identify audit log record clusters that specifically represent defined PCP tasks; and (2) identify variation in how tasks are completed without the need for ground-truth labels. To interpret the result, we used the following PARAFAC2 factors: a matrix representing the task definitions and a matrix containing the frequency measure of each task for each encounter. RESULTS PARAFAC2 automatically identified 4 clusters of audit log records that represent 4 common clinical encounter tasks: (1) medications' access, (2) notes' access, (3) order entry access, and (4) diagnosis modification. PARAFAC2 also identified the most common variants in how PCPs accomplish these tasks. It discovered variation in how the notes' access task was done, including identification of 9 distinct variants of notes access that explained 77% of the input data variation for notes. The discovered variants mapped to two known workflows for notes' access and to two distinct PCP user groups who accessed notes by either using the Visit Navigator or the Wrap-Up option. CONCLUSIONS Our results demonstrate that EHR audit log data can be rapidly processed to create higher-level constructed features that represent time-stamped PCP tasks.
Collapse
Affiliation(s)
- Ioakeim Perros
- Georgia Institute of Technology, Atlanta, GA, United States
| | - Xiaowei Yan
- Research Development & Dissemination, Sutter Health, Walnut Creek, CA, United States
| | - J B Jones
- Research Development & Dissemination, Sutter Health, Walnut Creek, CA, United States
| | - Jimeng Sun
- Georgia Institute of Technology, Atlanta, GA, United States
| | | |
Collapse
|
29
|
A systematic review of Lean in healthcare: a global prospective. INTERNATIONAL JOURNAL OF QUALITY & RELIABILITY MANAGEMENT 2019. [DOI: 10.1108/ijqrm-12-2018-0346] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Fostered by a rapid spread beyond the manufacturing sector, Lean philosophy for continuous improvement has been widely used in service organizations, primarily in the healthcare sector. However, there is a limited research on the motivating factors, challenges and benefits of implementing Lean in healthcare. Taking this as a valuable opportunity, the purpose of this paper is to present the key motivating factors, limitations or challenges of Lean deployment, benefits of Lean in healthcare and key gaps in the literature as an agenda for future research.
Design/methodology/approach
The authors used the secondary data from the literature (peer-reviewed journal articles) published between 2000 and 2016 to understand the state of the art. The systematic review identified 101 articles across 88 journals recognized by the Association of Business Schools ranking guide 2015.
Findings
The systematic review helped the authors to identify the evolution, current trends, research gaps and an agenda for future research for Lean in healthcare. A bouquet of motivating factors, challenges/limitations and benefits of Lean in healthcare are presented.
Practical implications
The implications of this work include directions for managers and healthcare professionals in healthcare organizations to embark on a focused Lean journey aligned with the strategic objectives. This work could serve as a valuable resource to both practitioners and researchers for learning, investigating and rightly adapting the Lean in the healthcare sector.
Originality/value
This study is perhaps one of the comprehensive systematic literature reviews covering an important agenda of Lean in Healthcare. All the text, figures and tables featured here are original work carried by five authors in collaboration (from three countries, namely, India, the USA and the UK).
Collapse
|
30
|
Rotter T, Plishka C, Lawal A, Harrison L, Sari N, Goodridge D, Flynn R, Chan J, Fiander M, Poksinska B, Willoughby K, Kinsman L. What Is Lean Management in Health Care? Development of an Operational Definition for a Cochrane Systematic Review. Eval Health Prof 2019; 42:366-390. [PMID: 29635950 PMCID: PMC6659584 DOI: 10.1177/0163278718756992] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Industrial improvement approaches such as Lean management are increasingly being adopted in health care. Synthesis is necessary to ensure these approaches are evidence based and requires operationalization of concepts to ensure all relevant studies are included. This article outlines the process utilized to develop an operational definition of Lean in health care. The literature search, screening, data extraction, and data synthesis processes followed the recommendations outlined by the Cochrane Collaboration. Development of the operational definition utilized the methods prescribed by Kinsman et al. and Wieland et al. This involved extracting characteristics of Lean, synthesizing similar components to establish an operational definition, applying this definition, and updating the definition to address shortcomings. We identified two defining characteristics of Lean health-care management: (1) Lean philosophy, consisting of Lean principles and continuous improvement, and (2) Lean activities, which include Lean assessment activities and Lean improvement activities. The resulting operational definition requires that an organization or subunit of an organization had integrated Lean philosophy into the organization's mandate, guidelines, or policies and utilized at least one Lean assessment activity or Lean improvement activity. This operational definition of Lean management in health care will act as an objective screening criterion for our systematic review. To our knowledge, this is the first evidence-based operational definition of Lean management in health care.
Collapse
Affiliation(s)
- Thomas Rotter
- Healthcare Quality Programs, School of Nursing, Queen's University,
Kingston, Canada
| | - Christopher Plishka
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon,
Canada
| | - Adegboyega Lawal
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon,
Canada
| | - Liz Harrison
- School of Rehabilitation Science, College of Medicine, University of
Saskatchewan, Saskatoon, Canada
| | - Nazmi Sari
- Department of Economics, University of Saskatchewan, Saskatoon, Canada
| | - Donna Goodridge
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Rachel Flynn
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - James Chan
- School of Health Sciences, University of Northern British Columbia,
Canada
| | - Michelle Fiander
- Assistant Research Professor, College of Pharmacy, Department of
Pharmacotherapy, University of Utah
| | - Bonnie Poksinska
- Department of Management and Engineering, Linköping University, Sweden
| | - Keith Willoughby
- Edwards School of Business, University of Saskatchewan, Saskatoon,
Canada
| | - Leigh Kinsman
- University of Tasmania and Tasmanian Health Service (North), Launceston,
Tasmania, Australia
| |
Collapse
|
31
|
Bijl A, Ahaus K, Ruël G, Gemmel P, Meijboom B. Role of lean leadership in the lean maturity-second-order problem-solving relationship: a mixed methods study. BMJ Open 2019; 9:e026737. [PMID: 31164365 PMCID: PMC6561417 DOI: 10.1136/bmjopen-2018-026737] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To investigate the relationship between lean adoption and problem-solving behaviour in nursing teams, and to explore the practices of lean leaders on nursing wards to reveal how they can stimulate second-order problem-solving within their teams. DESIGN A mixed-methods retrospective multiple case study using semistructured interviews. Interview data were used to assess the level of lean maturity (based on a customised validated instrument) and the level of second-order problem-solving (based on scenarios). Within-case and cross-case analyses were employed to identify lean leadership practices. SETTING 14 nursing teams, with different levels of lean maturity, in a Dutch hospital. PARTICIPANTS Three members of each nursing team were interviewed: the team leader, one nurse from the ward's core team for the lean-based quality improvement programme and one nurse outside the core team. INTERVENTIONS The nursing teams were in various phases of a lean-based quality improvement programme: 'The Productive Ward - Releasing Time to Care'. RESULTS A strongly significant positive relationship between lean maturity and second-order problem-solving was found: β=0.68, R2=0.46, p<0.001. Further, the results indicated a potential strengthening effect of lean leadership on this relationship. Seven lean leadership practices emerged from the data collected in a nursing ward setting: (1) convincing and setting an example; (2) unlocking individual and team potential; (3) solving problems systematically; (4) enthusing, actively participating and visualising; (5) developing self-managing teams; (6) sensing, as orchestrator, what is needed for change; and (7) listening, sharing information and appreciating. These practices have a strong link with transformational leadership. CONCLUSIONS As lean matures, nursing teams reach a higher level of second-order problem-solving. In later stages, lean leaders increasingly relinquish responsibility by developing self-managing teams.
Collapse
Affiliation(s)
- Arie Bijl
- Department of Operations, Faculty of Economics and Business, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Kees Ahaus
- Department of Operations, Faculty of Economics and Business, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Department of Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Gwenny Ruël
- Department of Operations, Faculty of Economics and Business, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Paul Gemmel
- Department of Innovation, Entrepreneurship and Service Management, Faculty of Economics and Business Administration, Ghent University, Gent, Belgium
| | - Bert Meijboom
- Department of Tranzo, Tilburg University, Tilburg, The Netherlands
| |
Collapse
|
32
|
Mousavi Isfahani H, Tourani S, Seyedin H. Features and Results of Conducted Studies Using a Lean Management Approach in Emergency Department in Hospital: A Systematic Review. Bull Emerg Trauma 2019; 7:9-20. [PMID: 30719461 PMCID: PMC6360007 DOI: 10.29252/beat-070102] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Objective: To perform a systematic review of the properties and results of the studies that their approaches are lean management in emergency departments and the factors which influence on their performance. Method: The necessary information in the first stage was collected by searching these keywords: "Lean principles" “Lean Six Sigma", "Lean Process", “Lean thinking”, “Lean Methodology”, “Toyota Production System lean processing”, "lean techniques", "emergency department”, “emergency medicine”, “emergency room” and “emergency care ” . And in the next stage the keywords such as “lean management” and “emergency” was collected from SID, Medlib, IranDoc, Google Scholar, MagIran, IranMedex data bases. For extracting the data data-extracting forms was prepared. The information we got from the forms was organized in information-extracting forms and was analyzed manually. The diagrams were drawn in Excel: 2010. Results: Finally, 26 essays have been included. Most of the studies were accomplished in Canada and U.S.A. only in one of the cases, the authors used the control group. Each of these terms, “lean techniques” and “lean principals”, with five times repetitions had the highest frequency. The most important team of implementation of lean management included: hospital management team or the manager of Emergency department, physicians, nurses, staffs and external counselors. Generally, 51 indicators were studied which among them the length of stay and the timing had the most frequency. After implementation of lean management, almost all studied indicators have significantly improved. 14 barriers, 14 facilitators and 10 effective factors were recognized in implementing the lean management. Conclusion: According to the studies, responsibility of organization’s senior management and his/her supports; increasing the knowledge of the characteristics and dimension of lean among the providers of health service; and decreasing the resistance and consulting with external counselors can have great effect on the success of lean management.
Collapse
Affiliation(s)
- Haleh Mousavi Isfahani
- Department of Health Services Management, School of Health Management and information Sciences, International Campus (IUMS-IC), Iran University of Medical Sciences, Tehran, Iran
| | - Sogand Tourani
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hesam Seyedin
- Department of Health in Disasters and Emergencies, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
33
|
Gupta S, Kapil S, Sharma M. Improvement of laboratory turnaround time using lean methodology. Int J Health Care Qual Assur 2018; 31:295-308. [PMID: 29790443 DOI: 10.1108/ijhcqa-08-2016-0116] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this paper is to discuss the implementation of lean methodology to reduce the turnaround time (TAT) of a clinical laboratory in a super speciality hospital. Delays in report delivery lead to delayed diagnosis increased waiting time and decreased customer satisfaction. The reduction in TAT will lead to increased patient satisfaction, quality of care, employee satisfaction and ultimately the hospital's revenue. Design/methodology/approach The generic causes resulting in increasing TAT of clinical laboratories were identified using lean tools and techniques such as value stream mapping (VSM), Gemba, Pareto Analysis and Root Cause Analysis. VSM was used as a tool to analyze the current state of the process and further VSM was used to design the future state with suggestions for process improvements. Findings This study identified 12 major non-value added factors for the hematology laboratory and 5 major non-value added factors for the biochemistry lab which were acting as bottlenecks resulting in limiting throughput. A four-month research study by the authors together with hospital quality department and laboratory staff members led to reduction of the average TAT from 180 to 95minutes in the hematology lab and from 268 to 208 minutes in the biochemistry lab. Practical implications Very few improvement initiatives in Indian healthcare are based on industrial engineering tools and techniques, which might be due to a lack of interaction between healthcare and engineering. The study provides a positive outcome in terms of improving the efficiency of services in hospitals and identifies a scope for lean in the Indian healthcare sector. Social implications Applying lean in the Indian healthcare sector gives its own potential solution to the problem caused, due to a wide gap between lean accessibility and lean implementation. Lean helped in changing the mindset of an organization toward providing the highest quality of services with faster delivery at an optimal cost. Originality/value This paper is an effort to reduce the gap between healthcare and industrial engineering and enhancing the use of lean practices in Indian healthcare. The study is motivated toward implementing lean methodology successfully in services.
Collapse
Affiliation(s)
- Shradha Gupta
- Malaviya National Institute of Technology Jaipur, Jaipur, India
| | - Sahil Kapil
- National Institute of Technical Teachers Training & Research, Chandigarh, India
| | - Monica Sharma
- Malaviya National Institute of Technology Jaipur, Jaipur, India
| |
Collapse
|
34
|
Migita R, Yoshida H, Rutman L, Woodward GA. Quality Improvement Methodologies: Principles and Applications in the Pediatric Emergency Department. Pediatr Clin North Am 2018; 65:1283-1296. [PMID: 30446063 DOI: 10.1016/j.pcl.2018.07.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The origins of quality improvement in health care trace back to industry. Lessons learned from the "flow production" system of the Ford Model-T assembly line in Michigan and the Toyota Production System led to direct applications of Lean and Six Sigma to improve health care systems. Emergency medicine is well suited as a testing and proving ground for quality improvement methodologies because of high patient volume and rapid turnover. This article reviews the history of quality improvement in health care, describes Lean principles in detail, and provides illustrative examples of applications of Lean and quality improvement methodologies in the pediatric emergency department.
Collapse
Affiliation(s)
- Russell Migita
- Department of Pediatrics, Division of Emergency Medicine and Emergency Department, Seattle Children's Hospital, University of Washington School of Medicine, MB.7.520, PO Box 5371, Seattle, WA 98145-5005, USA; UW Medicine Center for Scholarship in Patient Care Quality and Safety, UWMC Health Sciences, BB1240, Campus Box #356526, 1959 NE Pacific Street, Seattle, WA 98195, USA.
| | - Hiromi Yoshida
- Department of Pediatrics, Division of Emergency Medicine and Emergency Department, Seattle Children's Hospital, University of Washington School of Medicine, MB.7.520, PO Box 5371, Seattle, WA 98145-5005, USA
| | - Lori Rutman
- Department of Pediatrics, Division of Emergency Medicine and Emergency Department, Seattle Children's Hospital, University of Washington School of Medicine, MB.7.520, PO Box 5371, Seattle, WA 98145-5005, USA
| | - George A Woodward
- Department of Pediatrics, Division of Emergency Medicine and Emergency Department, Seattle Children's Hospital, University of Washington School of Medicine, MB.7.520, PO Box 5371, Seattle, WA 98145-5005, USA
| |
Collapse
|
35
|
Al-Farsi YM, Al-Balushi SM. Go Lean, Get Leaner: The application of lean management in Omani healthcare. Sultan Qaboos Univ Med J 2018; 18:e431-e432. [PMID: 30988959 PMCID: PMC6443269 DOI: 10.18295/squmj.2018.18.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/19/2019] [Accepted: 02/21/2019] [Indexed: 06/09/2023] Open
Affiliation(s)
- Yahya M. Al-Farsi
- Department of Family Medicine & Public Health, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Shahid M. Al-Balushi
- Department of Operations Management & Business Statistics, College of Economics & Political Science, Sultan Qaboos University, Muscat, Oman
| |
Collapse
|
36
|
Sánchez M, Suárez M, Asenjo M, Bragulat E. Improvement of emergency department patient flow using lean thinking. Int J Qual Health Care 2018; 30:250-256. [PMID: 29447352 DOI: 10.1093/intqhc/mzy017] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 01/25/2018] [Indexed: 11/12/2022] Open
Abstract
Objective To apply lean thinking in triage acuity level-3 patients in order to improve emergency department (ED) throughtput and waiting time. Design A prospective interventional study. Setting An ED of a tertiary care hospital. Participants Triage acuity level-3 patients. Intervention(s) To apply lean techniques such as value stream mapping, workplace organization, reduction of wastes and standardization by the frontline staff. Main Outcome Measure(s) Two periods were compared: (i) pre-lean: April-September, 2015; and (ii) post-lean: April-September, 2016. Variables included: median process time (time from beginning of nurse preparation to the end of nurse finalization after doctor disposition) of both discharged and transferred to observation patients; median length of stay; median waiting time; left without being seen, 72-h revisit and mortality rates, and daily number of visits. There was no additional staff or bed after lean implementation. Results Despite an increment in the daily number of visits (+8.3%, P < 0.001), significant reductions in process time of discharged (182 vs 160 min, P < 0.001) and transferred to observation (186 vs 176 min, P < 0.001) patients, in length of stay (389 vs 329 min, P < 0.001), and in waiting time (71 vs 48 min, P < 0.001) were achieved after lean implementation. No significant differences were registered in left without being seen rate (5.23% vs 4.95%), 72-h revisit rate (3.41% vs 3.93%), and mortality rate (0.23% vs 0.15%). Conclusion Lean thinking is a methodology that can improve triage acuity level-3 patient flow in the ED, resulting in better throughput along with reduced waiting time.
Collapse
Affiliation(s)
- Miquel Sánchez
- Emergency Department, Hospital Clínic de Barcelona, Grup d'Investigació 'Urgencias: procesos y patologias', IDIBAPS, Villarroel 160, 08036 Barcelona, Catalonia, Spain
| | - Montse Suárez
- Emergency Department, Hospital Clínic de Barcelona, Villarroel 160, 08036 Barcelona, Catalonia, Spain
| | - María Asenjo
- Emergency Department, Hospital Clínic de Barcelona, Villarroel 160, 08036 Barcelona, Catalonia, Spain
| | - Ernest Bragulat
- Emergency Department, Hospital Clínic de Barcelona, Grup d'Investigació 'Urgencias: procesos y patologias', IDIBAPS, Villarroel 160, 08036 Barcelona, Catalonia, Spain
| |
Collapse
|
37
|
Flynn R, Newton AS, Rotter T, Hartfield D, Walton S, Fiander M, Scott SD. The sustainability of Lean in pediatric healthcare: a realist review. Syst Rev 2018; 7:137. [PMID: 30205842 PMCID: PMC6134523 DOI: 10.1186/s13643-018-0800-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 08/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lean is a quality improvement management system from the Toyota manufacturing industry. Since the early 2000's, Lean has been used as an intervention for healthcare improvement. Lean is intended to reduce costs and improve customer value through continuous improvement. Despite its extensive use, the contextual factors and mechanisms that influence the sustainability of Lean in healthcare have not been well studied. Realist synthesis is one approach to "unpack" the causal explanations of how and why Lean is sustained or not in healthcare. We conducted a realist synthesis using the context (C) + mechanim (M) = outcome (O) heuristic, to further develop and refine an initial program theory with seven CMO hypotheses, on the sustainability of Lean efforts across pediatric healthcare. METHODS Our search strategy was multi-pronged, iterative, and purposeful in nature, consisting of database, gray literature, and contact with three healthcare organizations known for Lean implementation. We included primary research studies, published and unpublished case studies or reports, if they included Lean implementation with a pediatric focus and sustainability outcome. We used the Normalization Process Theory and the National Health Services Sustainability Model, an operational definition for Lean and a comprehensive definition for sustainability as guidance for data extraction and analysis. Our initial program theory with was refined using a blend of abductive and retroductive analytical processes. RESULTS We identified six published primary research studies, two published quality improvement case studies, and three unpublished quality improvement case reports. Five CMO hypotheses from our initial program theory were substantially supported after synthesis, "sense-making and value congruency," "staff engagement and empowerment," and the "ripple effect" or causal pathway between Lean implementation outcomes that served as facilitating or hindering contexts for sustainability. Overall, there was variation with the conceptualization and measurement of sustainability. CONCLUSIONS This study is the first to examine Lean sustainability in pediatric healthcare using realist methods. Future research should examine whether the predictors of implementation are the same or different to sustainability and evaluate the underlying mechanisms that influence the sustainability of Lean. There is also a need for research to develop and test conceptual models and frameworks on sustainability. SYSTEMATIC REVIEW REGISTRATION PROSPERO-CRD42015032252 .
Collapse
Affiliation(s)
- Rachel Flynn
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Amanda S. Newton
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Thomas Rotter
- Healthcare Quality Programs, Queen’s University School of Nursing, Kingston, ON K7L 3N6 Canada
| | - Dawn Hartfield
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Sarah Walton
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Michelle Fiander
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, L.S. Skaggs Building 4838, Salt Lake City, UT 84112 USA
| | - Shannon D. Scott
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
| |
Collapse
|
38
|
Prætorius T, Chaudhuri A, Venkataramanaiah S, Hasle P, Singh A. Achieving Better Integration in Trauma Care Delivery in India. JOURNAL OF HEALTH MANAGEMENT 2018. [DOI: 10.1177/0972063418779896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Interdependencies among healthcare providers result in complex healthcare supply chains with fragmented healthcare processes characterized by coordination failure and incentive misalignment. In developing countries where resources are scarce such coordination failures can have a severe impact on patient health. However, limited knowledge exists about how coordination takes place across and within the different healthcare service providers and how this influences hospital transfer time and length of stay. This article research this gap by studying trauma care delivery in India using a patient survey ( n = 104). The Indian healthcare system is insightful because India has to provide low-cost care to large populations living in geographically big areas and the healthcare infrastructure struggles to meet increasing demands. The findings suggest mechanisms to better integrate the processes from the accident site to the hospital which include setting up referral processes, 24-hour ambulance services, using third-party coordinators and process improvement within the hospital following lean principles.
Collapse
Affiliation(s)
- Thim Prætorius
- Sustainable Production, Department of Materials and Production, Aalborg University Copenhagen, Denmark
| | - Atanu Chaudhuri
- Sustainable Production, Department of Materials and Production, Aalborg University Copenhagen, Denmark
| | - S. Venkataramanaiah
- Indian Institute of Management Lucknow, Noida Campus, Noida, Uttar Pradesh, India
| | - Peter Hasle
- Sustainable Production, Department of Materials and Production, Aalborg University Copenhagen, Denmark
| | - Ajai Singh
- Head of Department of Paediatric Orthopaedics, King George’s Medical University, Lucknow, Uttar Pradesh, India
| |
Collapse
|
39
|
Henrique DB, Godinho Filho M. A systematic literature review of empirical research in Lean and Six Sigma in healthcare. TOTAL QUALITY MANAGEMENT & BUSINESS EXCELLENCE 2018. [DOI: 10.1080/14783363.2018.1429259] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Moacir Godinho Filho
- Department of Industrial Engineering, Federal University of São Carlos, São Carlos, SP, Brazil
| |
Collapse
|
40
|
Nicosia FM, Park LG, Gray CP, Yakir MJ, Hung DY. Nurses' Perspectives on Lean Redesigns to Patient Flow and Inpatient Discharge Process Efficiency. Glob Qual Nurs Res 2018; 5:2333393618810658. [PMID: 30480041 PMCID: PMC6249655 DOI: 10.1177/2333393618810658] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 10/09/2018] [Accepted: 10/11/2018] [Indexed: 10/27/2022] Open
Abstract
As hospitals around the world increasingly face pressure to improve efficiency, "Lean" process improvement has become a popular approach to improving patient flow. In this article, we examine nurses' perspectives on the implementation of Lean redesigns to the inpatient discharge process. We found that nurses experienced competing demands and tensions related to their time and professional roles and responsibilities as a result of Lean. Four main themes included (a) addressing the needs of individual patients, while still maintaining overall patient flow; (b) meeting discharge efficiency targets while also achieving high patient satisfaction scores; (c) "wasting time" to save time; and (d) the "real" work of providing clinical care versus the "Lean" work of process improvement. Our findings highlight the importance of soliciting hospital nurses' perspectives when implementing Lean process improvements to improve efficiency and patient flow.
Collapse
Affiliation(s)
- Francesca M. Nicosia
- University of California, San Francisco, California, USA
- San Francisco Veterans Medical Center, San Francisco, California, USA
| | - Linda G. Park
- University of California, San Francisco, California, USA
- San Francisco Veterans Medical Center, San Francisco, California, USA
| | | | - Maayan J. Yakir
- Palo Alto Medical Foundation, Research Institute of Sutter Health, Mountain View, California, USA
| | - Dorothy Y. Hung
- Palo Alto Medical Foundation, Research Institute of Sutter Health, Mountain View, California, USA
| |
Collapse
|
41
|
Magalhães ALP, Erdmann AL, Silva ELD, Santos JLGD. Lean thinking in health and nursing: an integrative literature review. Rev Lat Am Enfermagem 2017; 24:e2734. [PMID: 27508906 PMCID: PMC4990033 DOI: 10.1590/1518-8345.0979.2734] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 11/13/2015] [Indexed: 11/30/2022] Open
Abstract
Objectives: to demonstrate the scientific knowledge developed on lean thinking in health,
highlighting the impact and contributions in health care and nursing. Method: an integrative literature review in the PubMed, CINAHL, Scopus, Web of Science,
Emerald, LILACS and SciELO electronic library databases, from 2006 to 2014, with
syntax keywords for each data base, in which 47 articles were selected for
analysis. Results: the categories were developed from the quality triad proposed by Donabedian:
structure, process and outcome. Lean thinking is on the rise in health surveys,
particularly internationally, especially in the USA and UK, improving the
structure, process and outcome of care and management actions. However, it is an
emerging theme in nursing. Conclusion: this study showed that the use of lean thinking in the context of health has a
transforming effect on care and organizational aspects, promoting advantages in
terms of quality, safety and efficiency of health care and nursing focused on the
patient.
Collapse
Affiliation(s)
- Aline Lima Pestana Magalhães
- PhD, Adjunct Professor, Departamento de Enfermagem, Universidade do Estado de Santa Catarina, Chapecó, SC, Brazil
| | - Alacoque Lorenzini Erdmann
- PhD, Full Professor, Departamento de Enfermagem, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Elza Lima da Silva
- PhD, Adjunct Professor, Departamento de Enfermagem, Universidade Federal do Maranhão, Florianópolis, SC, Brazil
| | - José Luís Guedes Dos Santos
- PhD, Adjunct Professor, Departamento de Enfermagem, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| |
Collapse
|
42
|
Rotter T, Plishka CT, Adegboyega L, Fiander M, Harrison EL, Flynn R, Chan JG, Kinsman L. Lean management in health care: effects on patient outcomes, professional practice, and healthcare systems. Cochrane Database Syst Rev 2017; 2017:CD012831. [PMCID: PMC6486096 DOI: 10.1002/14651858.cd012831] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess effects of Lean management in health care on patient, professional, and systems outcomes by addressing the following question. What are the effects of Lean management interventions in health care on patient outcomes, professional practice, and healthcare systems? What are the effects of Lean management interventions in health care on patient outcomes, professional practice, and healthcare systems? To answer the following questions in addressing secondary objectives: What are the effects of Lean management interventions in combination with other management systems (e.g. Six Sigma) on patient outcomes, professional practice, and healthcare systems (utilisation and access, adverse effects, cost)? Is the effectiveness of Lean interventions influenced by the setting (e.g. Emergency Department, Laboratory, Pharmacy) in which they are implemented? What are the effects of Lean management interventions in combination with other management systems (e.g. Six Sigma) on patient outcomes, professional practice, and healthcare systems (utilisation and access, adverse effects, cost)? Is the effectiveness of Lean interventions influenced by the setting (e.g. Emergency Department, Laboratory, Pharmacy) in which they are implemented?
Collapse
Affiliation(s)
| | - Christopher T Plishka
- University of SaskatchewanCollege of Pharmacy and NutritionE3315 Health Sciences Building, 104 Clinic PlaceSaskatoonCanadaS7N 5E5
| | - Lawal Adegboyega
- University of SaskatchewanCollege of Pharmacy and NutritionE3315 Health Sciences Building, 104 Clinic PlaceSaskatoonCanadaS7N 5E5
| | | | - Elizabeth L Harrison
- University of SaskatchewanSchool of Physical Therapy, College of MedicineSchool of Physical Therapy, College of MedicineSuite 3400, 3rd Floor, 104 Clinic Place, University of SaskatchewanSaskatoonCanada
| | - Rachel Flynn
- University of AlbertaFaculty of Nursing11405 87 Avenue, level 3, Edmonton Clinic Health AcademyEdmontonCanadaT6G1C9
| | - James G Chan
- University of Northern British ColumbiaSchool of Health SciencesPrince GeorgeCanada
| | - Leigh Kinsman
- University of TasmaniaHealthLaunceston Clinical School, Locked Bag 1377HobartAustralia7250
| |
Collapse
|
43
|
Nowak M, Pfaff H, Karbach U. Does Value Stream Mapping affect the structure, process, and outcome quality in care facilities? A systematic review. Syst Rev 2017; 6:170. [PMID: 28838320 PMCID: PMC5571664 DOI: 10.1186/s13643-017-0563-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 08/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Quality improvement within health and social care facilities is needed and has to be evidence-based and patient-centered. Value Stream Mapping, a method of Lean management, aims to increase the patients' value and quality of care by a visualization and quantification of the care process. The aim of this research is to examine the effectiveness of Value Stream Mapping on structure, process, and outcome quality in care facilities. METHODS A systematic review is conducted. PubMed, EBSCOhost, including Business Source Complete, Academic Search Complete, PSYCInfo, PSYNDX, SocINDEX with Full Text, Web of Knowledge, and EMBASE ScienceDirect are searched in February 2016. All peer-reviewed papers evaluating Value Stream Mapping and published in English or German from January 2000 are included. For data synthesis, all study results are categorized into Donabedian's model of structure, process, and outcome quality. To assess and interpret the effectiveness of Value Stream Mapping, the frequencies of the results statistically examined are considered. RESULTS Of the 903 articles retrieved, 22 studies fulfill the inclusion criteria. Of these, 11 studies are used to answer the research question. Value Stream Mapping has positive effects on the time dimension of process and outcome quality. It seems to reduce non-value-added time (e.g., waiting time) and length of stay. All study designs are before and after studies without control, and methodologically sophisticated studies are missing. CONCLUSIONS For a final conclusion about Value Stream Mapping's effectiveness, more research with improved methodology is needed. Despite this lack of evidence, Value Stream Mapping has the potential to improve quality of care on the time dimension. The contextual influence has to be investigated to make conclusions about the relationship between different quality domains when applying Value Stream Mapping. However, for using this review's conclusion, the limitation of including heterogeneous and potentially biased results has to be considered.
Collapse
Affiliation(s)
- Marina Nowak
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), Faculty of Human Sciences, Faculty of Medicine, University of Cologne, Eupener Strasse 129, 50933 Cologne, Germany
| | - Holger Pfaff
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), Faculty of Human Sciences, Faculty of Medicine, University of Cologne, Eupener Strasse 129, 50933 Cologne, Germany
| | - Ute Karbach
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), Faculty of Human Sciences, Faculty of Medicine, University of Cologne, Eupener Strasse 129, 50933 Cologne, Germany
| |
Collapse
|
44
|
Sari N, Rotter T, Goodridge D, Harrison L, Kinsman L. An economic analysis of a system wide Lean approach: cost estimations for the implementation of Lean in the Saskatchewan healthcare system for 2012-2014. BMC Health Serv Res 2017; 17:523. [PMID: 28774301 PMCID: PMC5543735 DOI: 10.1186/s12913-017-2477-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 07/27/2017] [Indexed: 11/10/2022] Open
Abstract
Background The costs of investing in health care reform initiatives to improve quality and safety have been underreported and are often underestimated. This paper reports direct and indirect cost estimates for the initial phase of the province-wide implementation of Lean activities in Saskatchewan, Canada. Methods In order to obtain detailed information about each type of Lean event, as well as the total number of corresponding Lean events, we used the Provincial Kaizen Promotion Office (PKPO) Kaizen database. While the indirect cost of Lean implementation has been estimated using the corresponding wage rate for the event participants, the direct cost has been estimated using the fees paid to the consultant and other relevant expenses. Results The total cost for implementation of Lean over two years (2012–2014), including consultants and new hires, ranged from $44 million CAD to $49.6 million CAD, depending upon the assumptions used. Consultant costs accounted for close to 50% of the total. The estimated cost of Lean events alone ranged from $16 million CAD to $19.5 million CAD, with Rapid Process Improvement Workshops requiring the highest input of resources. Conclusions Recognizing the substantial financial and human investments required to undertake reforms designed to improve quality and contain cost, policy makers must carefully consider whether and how these efforts result in the desired transformations. Evaluation of the outcomes of these investments must be part of the accountability framework, even prior to implementation. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2477-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Nazmi Sari
- Department of Economics, University of Saskatchewan, Arts 815, 9 Campus Drive, Saskatoon, SK, S7N 5A5, Canada.
| | - Thomas Rotter
- College of Pharmacy & Nutrition, University of Saskatchewan, Saskatoon, SK, S7N 5A5, Canada
| | - Donna Goodridge
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Liz Harrison
- School of Physical Therapy, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Leigh Kinsman
- University of Tasmania and Tasmanian Health Organisation (North), Launceston, TAS, Australia
| |
Collapse
|
45
|
Hussain M, Malik M. Prioritizing lean management practices in public and private hospitals. J Health Organ Manag 2017; 30:457-74. [PMID: 27119397 DOI: 10.1108/jhom-08-2014-0135] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose - The purpose of this paper is to prioritize 21 healthcare wastes in public and private hospitals of United Arab Emirates (UAE). Design/methodology/approach - Seven healthcare wastes linked with lean management are further decomposed in to sub-criteria and to deal with this complexity of multi criteria decision-making process, analytical hierarchical process (AHP) method is used in this research. Findings - AHP framework for this study resulted in a ranking of 21 healthcare wastes in public and private hospitals of UAE. It has been found that management in private healthcare systems of UAE is putting more emphasis on the inventory waste. On the other hand, over processing waste has got highest weight in public hospitals of UAE. Research limitations/implications - The future directions of this research would be to apply a lean set of tools for the value stream optimization of the prioritized key improvement areas. Practical implications - This is a contribution to the continuing research into lean management, giving practitioners and designers a practical way for measuring and implementing lean practices across health organizations. Originality/value - The contribution of this research, through successive stages of data collection, measurement analysis and refinement, is a set of reliable and valid framework that can be subsequently used in conceptualization, prioritization of the waste reduction strategies in healthcare management.
Collapse
Affiliation(s)
- Matloub Hussain
- College of Business Administration (COBA), Abu Dhabi University, Abu Dhabi, UAE
| | - Mohsin Malik
- College of Business Administration (COBA), Abu Dhabi University, Abu Dhabi, UAE
| |
Collapse
|
46
|
Gabutti I, Mascia D, Cicchetti A. Exploring "patient-centered" hospitals: a systematic review to understand change. BMC Health Serv Res 2017; 17:364. [PMID: 28532463 PMCID: PMC5439229 DOI: 10.1186/s12913-017-2306-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 05/11/2017] [Indexed: 11/23/2022] Open
Abstract
Background The healthcare scenario in developed countries is changing deeply: patients, who are frequently affected by multi-pathological chronic conditions, have risen their expectations. Simultaneously, there exist dramatic financial pressures which require healthcare organizations to provide more and better services with equal (or decreasing) resources. In response to these challenges, hospitals are facing radical transformations by bridging, redesigning and engaging their organization and staff. Methods This study has the ambitious aim to shed light and clearly label the trends of change hospitals are enhancing in developed economies, in order to fully understand the presence of common trends and which organizational models and features are inspiring the most innovative organizations. The purpose is to make stock of what is known in the field of hospital organization about how hospitals are changing, as well as of how such change may be implemented effectively through managerial tools. To do so the methodology adopted integrates a systematic literature review to a wider engaged research approach. Results Evidence suggests that the three main pillars of change of the system are given by the progressive patient care model, the patient-centered approach and the lean approach. However, there emerge a number of gaps in what is known about how to exploit drivers of change and their effects. Conclusions This study confirms that efforts in literature are concentrated in analyzing circumscribed experiences in the implementation of new models and approaches, failing therefore to extend the analysis at the organizational and inter-organizational level in order to legitimately draw consequences to be generalized. There seem to be a number of “gaps” in what is known about how to exploit drivers of change and their effects, suggesting that the research approach privileged till now fails in providing a clear guidance to policy makers and to organizations’ management on how to concretely and effectively implement new organizational models. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2306-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Irene Gabutti
- Department of management, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Rome, Italy.
| | - Daniele Mascia
- Department of Management, University of Bologna, Bologna, Italy
| | - Americo Cicchetti
- Department of management, Università Cattolica del Sacro Cuore, Rome, 00168, RM, Italy
| |
Collapse
|
47
|
Patri R, Suresh M. Factors influencing lean implementation in healthcare organizations: An ISM approach. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2017. [DOI: 10.1080/20479700.2017.1300380] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Rojalin Patri
- Amrita School of Business, Amrita Vishwa Vidyapeetham, Amrita University, Coimbatore, India
| | - M. Suresh
- Amrita School of Business, Amrita Vishwa Vidyapeetham, Amrita University, Coimbatore, India
| |
Collapse
|
48
|
Kaltenbrunner M, Bengtsson L, Mathiassen SE, Engström M. A questionnaire measuring staff perceptions of Lean adoption in healthcare: development and psychometric testing. BMC Health Serv Res 2017; 17:235. [PMID: 28340573 PMCID: PMC5364711 DOI: 10.1186/s12913-017-2163-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 03/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND During the past decade, the concept of Lean has spread rapidly within the healthcare sector, but there is a lack of instruments that can measure staff's perceptions of Lean adoption. Thus, the aim of the present study was to develop a questionnaire measuring Lean in healthcare, based on Liker's description of Lean, by adapting an existing instrument developed for the service sector. METHODS A mixed-method design was used. Initially, items from the service sector instrument were categorized according to Liker's 14 principles describing Lean within four domains: philosophy, processes, people and partners and problem-solving. Items were lacking for three of Liker's principles and were therefore developed de novo. Think-aloud interviews were conducted with 12 healthcare staff from different professions to contextualize and examine the face validity of the questionnaire prototype. Thereafter, the adjusted questionnaire's psychometric properties were assessed on the basis of a cross-sectional survey among 386 staff working in primary care. RESULTS The think-aloud interviews led to adjustments in the questionnaire to better suit a healthcare context, and the number of items was reduced. Confirmatory factor analysis of the adjusted questionnaire showed a generally acceptable correspondence with Liker's description of Lean. Internal consistency, measured using Cronbach's alpha, for the factors in Liker's description of Lean was 0.60 for the factor people and partners, and over 0.70 for the three other factors. Test-retest reliability measured by the intra-class correlation coefficient ranged from 0.77 to 0.88 for the four factors. CONCLUSIONS We designed a questionnaire capturing staff's perceptions of Lean adoption in healthcare on the basis of Liker's description. This Lean in Healthcare Questionnaire (LiHcQ) showed generally acceptable psychometric properties, which supports its usability for measuring Lean adoption in healthcare. We suggest that further research focus on verifying the usability of LiHcQ in other healthcare settings, and on adjusting the instrument if needed.
Collapse
Affiliation(s)
- Monica Kaltenbrunner
- Faculty of Health and Occupational Studies, University of Gävle, 801 76 Gävle, Sweden
| | - Lars Bengtsson
- Faculty of Engineering and Sustainable Development, University of Gävle, 801 76 Gävle, Sweden
| | - Svend Erik Mathiassen
- Faculty of Health and Occupational Studies, University of Gävle, 801 76 Gävle, Sweden
| | - Maria Engström
- 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 Shi, China
| |
Collapse
|
49
|
McCulloch P, Morgan L, Flynn L, Rivero-Arias O, Martin G, Collins G, New S. Safer delivery of surgical services: a programme of controlled before-and-after intervention studies with pre-planned pooled data analysis. PROGRAMME GRANTS FOR APPLIED RESEARCH 2016. [DOI: 10.3310/pgfar04190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BackgroundHigh rates of iatrogenic harm have been confirmed in observational studies of surgery. Most interventions designed to reduce this have been targeted at either workplace culture or operational systems. We hypothesised that an integrated intervention addressing both culture and system might be more effective than either approach alone.ObjectiveTo evaluate interventions designed to improve surgical team performance by impacting culture or systems in isolation or combination.DesignFive controlled intervention experiments, addressing system, culture or both, were performed in operating theatres. A final whole-system intervention study integrated approaches that showed benefit in these experiments. The five linked studies were subjected to a pre-planned pooled analysis to identify the effects of interventions, combinations and confounders. A qualitative interview study provided explanatory data on the mechanisms of intervention success and failure. An economic analysis was conducted.SettingOperating theatres in five hospitals, performing orthopaedic, trauma, vascular and plastic surgery were used for the linked studies. The final study occurred in a tertiary referral neurosurgery unit.ParticipantsThe main study subjects were clinical staff. Patient outcomes, both clinical and patient reported, were collected as secondary outcome measures.InterventionsThe interventions tested were (1) teamwork training (TT) based on the aviation crew resource management model, (2) the development of a set of standard operating procedures (SOPs), (3) a safety improvement programme based on lean principles, (4) TT plus SOPs and (5) TT plus lean. The final intervention used elements of all three strategies.Main outcome measuresPrimary outcomes were team non-technical skills [as measured by the Oxford Non-Technical Skills (NOTECHS) II scale score] and team technical performance (via the ‘glitch count’). Secondary outcomes were compliance with the World Health Organization (WHO)’s checklist procedures, patient length of stay, readmissions, 30-day mortality, complications and patient-reported outcome measures [as measured by the European Quality of Life-5 Dimensions (EQ-5D)]. A qualitative interview study provided explanatory data on the mechanisms of intervention success and failure. An economic analysis was conducted.Data sourcesDirect observation of whole operations, clinical records, hospital information systems and EQ-5D questionnaires. The qualitative study used semistructured interviews.Statistical methodsIndividual studies were analysed using two-way analysis of variance, and an overall individual patient pooled analysis was performed. Methods validation studies and other analyses used chi-squared test, correlation and regression methods as appropriate.ResultsWe studied 453 operations. The results of single interventions were inconsistent. TT alone improved non-technical skills and WHO compliance (p < 0.001) but not technical performance, whereas the systems interventions (lean and SOP) improved non-technical skills and technical performance (p < 0.001), but were less effective in improving WHO compliance. The integrated intervention approaches improved all aspects of team performance except time-out attempt rate, whereas the single approaches were significantly poorer at improving checklist compliance (p < 0.001) and failed to improve glitch rate. Combining all three strategies did not increase the percentage of successful projects. The qualitative analysis confirmed that integrated interventions better addressed the breadth of challenges that face surgical safety but also indicated that differences in implementation between integrated- and single-intervention studies amplified their differential effect.ConclusionsA combination of TT plus systems improvement training appears more effective in improving team performance than either approach alone. An implementation strategy based on an understanding of the barriers to change in hospitals is important for success.Future workMore work is required to understand and measure barriers to safety improvement. Implementation strategies need to be tested empirically. Methods for delivering integrated interventions on a larger scale need development. A cluster randomised trial of the integrated-systems/culture-improvement approach is warranted.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
Collapse
Affiliation(s)
- Peter McCulloch
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Lauren Morgan
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Lorna Flynn
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | | | - Graham Martin
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Gary Collins
- Centre for Statistics in Medicine, University of Oxford, Botnar Research Centre, Oxford, UK
| | - Steve New
- Saïd Business School, University of Oxford, Oxford, UK
| |
Collapse
|
50
|
Meschi T, Ticinesi A, Prati B, Montali A, Ventura A, Nouvenne A, Borghi L. A novel organizational model to face the challenge of multimorbid elderly patients in an internal medicine setting: a case study from Parma Hospital, Italy. Intern Emerg Med 2016; 11:667-76. [PMID: 26846233 DOI: 10.1007/s11739-016-1390-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 01/09/2016] [Indexed: 11/25/2022]
Abstract
Continuous increase of elderly patients with multimorbidity and Emergency Department (ED) overcrowding are great challenges for modern medicine. Traditional hospital organizations are often too rigid to solve them without consistently rising healthcare costs. In this paper we present a new organizational model achieved at Internal Medicine and Critical Subacute Care Unit of Parma University Hospital, Italy, a 106-bed internal medicine area organized by intensity of care and specifically dedicated to such patients. The unit is partitioned into smaller wards, each with a specific intensity level of care, including a rapid-turnover ward (mean length of stay <4 days) admitting acutely ill patients from the ED, a subacute care ward for chronic critically ill subjects and a nurse-managed ward for stable patients who have socio-economic trouble preventing discharge. A very-rapid-turnover ("come'n'go") ward has also been instituted to manage sudden ED overflows. Continuity, effectiveness, safety and appropriateness of care are guaranteed by an innovative figure called "flow manager," with skilled clinical experience and managerial attitude, and by elaboration of an early personalized discharge plan anticipating every patient's needs according to lean methodology principles. In 2012-2014, this organizational model, compared with other peer units of the hospital and of other teaching hospitals of the region, showed a better performance, efficacy and effectiveness indexes calculated on Regional Hospital Discharge Records database system, allowing a capacity to face a massive (+22 %) rise in medical admissions from the ED. Further studies are needed to validate this model from a patient outcome point of view.
Collapse
Affiliation(s)
- Tiziana Meschi
- Internal Medicine and Critical Subacute Care Unit, Geriatric-Rehabilitation Department, Parma University Hospital and Clinical and Experimental Medicine Department, University of Parma, Via A. Gramsci 14, 43126, Parma, Italy.
| | - Andrea Ticinesi
- Internal Medicine and Critical Subacute Care Unit, Geriatric-Rehabilitation Department, Parma University Hospital and Clinical and Experimental Medicine Department, University of Parma, Via A. Gramsci 14, 43126, Parma, Italy
| | - Beatrice Prati
- Internal Medicine and Critical Subacute Care Unit, Geriatric-Rehabilitation Department, Parma University Hospital and Clinical and Experimental Medicine Department, University of Parma, Via A. Gramsci 14, 43126, Parma, Italy
| | | | - Antonio Ventura
- Business Management Control Unit, General Management Direction, Parma University Hospital, Parma, Italy
| | - Antonio Nouvenne
- Internal Medicine and Critical Subacute Care Unit, Geriatric-Rehabilitation Department, Parma University Hospital and Clinical and Experimental Medicine Department, University of Parma, Via A. Gramsci 14, 43126, Parma, Italy
| | - Loris Borghi
- Internal Medicine and Critical Subacute Care Unit, Geriatric-Rehabilitation Department, Parma University Hospital and Clinical and Experimental Medicine Department, University of Parma, Via A. Gramsci 14, 43126, Parma, Italy
| |
Collapse
|