Lean-ing Method in an Emergency Department of the Italian Epicenter of the COVID-19 Outbreak: When the Algorithm Makes Difference

Best Practices on Radiology Department Workflow: Tips from the Impact of the COVID-19 Lockdown on an Italian University Hospital

Purpose: The workload of the radiology department (RD) of a university hospital in northern Italy dramatically changed during the COVID-19 outbreak. The restrictive measures of the COVID-19 pandemic lockdown influenced the use of radiological services and particularly in the emergency department (ED). Methods: Data on diagnostic services from March 2020 to May 2020 were retrospectively collected and analysed in aggregate form and compared with those of the same timeframe in the previous year. Data were sorted by patient type in the following categories: inpatients, outpatients, and ED patients; the latter divided in “traumatic” and “not traumatic” cases. Results: Compared to 2019, 6449 fewer patients (−32.6%) were assisted in the RD. This decrease was more pronounced for the emergency radiology unit (ERU) (−41%) compared to the general radiology unit (−25.7%). The proportion of investigations performed for trauma appeared to decrease significantly from 14.8% to 12.5% during the COVID-19 emergency (p < 0.001). Similarly, the proportion of assisted traumatic patients decreased from 16.6% to 12.5% (p < 0.001). The number of emergency patients assisted by the RD was significantly reduced from 45% during routine activity to 39.4% in the COVID-19 outbreak (p < 0.001). Conclusion: The COVID-19 outbreak had a tremendous impact on all radiology activities. We documented a drastic reduction in total imaging volume compared to 2019 because of both the pandemic and the lockdown. In this context, investigations performed for trauma showed a substantial decrease.

The role of lean in healthcare during COVID-19 pandemic

Purpose

The 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/approach

Drawing 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.

Findings

The 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/implications

The 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 implications

The 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/value

Given 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.

Systems and Industries in Response to COVID-19 Crisis: Closing Remarks

Many industries and systems have faced consequences as a result of the COVID-19 outbreak. In this time, we are happy to had the publication of a Special Issue of Applied System Innovation titled “Systems and Industries in Response to the COVID-19 Crisis”. This editorial article contains the special issue’s closing remarks. However, while the scope of this given special issue grabbed the interest of practitioners and scholars, there is still much to be learned from COVID-19’s experience. Thus, suggestions for future special issues are included with this letter.