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Pierce A, Teeling SP, McNamara M, O’Daly B, Daly A. Using Lean Six Sigma in a Private Hospital Setting to Reduce Trauma Orthopedic Patient Waiting Times and Associated Administrative and Consultant Caseload. Healthcare (Basel) 2023; 11:2626. [PMID: 37830663 PMCID: PMC10572702 DOI: 10.3390/healthcare11192626] [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: 08/14/2023] [Revised: 09/08/2023] [Accepted: 09/25/2023] [Indexed: 10/14/2023] Open
Abstract
In Ireland, the extent of outpatient orthopedic waiting lists results in long waiting times for patients, delays in processing referrals, and variation in the consultant caseload. At the study site, the Define, Measure, Analyze, Improve, and Control (DMAIC) Lean Six Sigma framework was applied to evaluate sources of Non-Value-Added (NVA) activity in the process of registering and triaging patients referred to the trauma orthopedic service from the Emergency Department. A pre- (October-December 2021)/post- (April-August 2022) intervention design was employed, utilizing Gemba, Process Mapping, and the TIMWOODS tool. Embracing a person-centered approach, stakeholder Voice of Customer feedback was sought at each stage of the improvement process. Following data collection and analysis, a co-designed pilot intervention (March 2022) was implemented, consisting of a new triage template, dedicated trauma clinic slots, a consultant triage roster, and a new option to refer directly to physiotherapy services. This resulted in the total wait time of patients for review being reduced by 34%, a 51% reduction in the process steps required for registering, and an increase in orthopedic consultant clinic capacity of 22%. The reduction in NVA activities in the process and the increase in management options for triaging consultants have delivered a more efficient trauma and orthopedic pathway.
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Affiliation(s)
- Anthony Pierce
- Beacon Hospital, Beacon Court, Bracken Rd, Sandyford Business Park, Sandyford, D18 AK68 Dublin, Ireland
| | - Seán Paul Teeling
- UCD Centre for Interdisciplinary Research, Education & Innovation in Health Systems, School of Nursing, Midwifery & Health Systems UCD Health Sciences Centre, D04 VIW8 Dublin, Ireland; (S.P.T.)
- Centre for Person-Centered Practice Research Division of Nursing, School of Health Sciences, Queen Margaret University Drive, Queen Margaret University, Musselburgh EH21 6UU, UK
| | - Martin McNamara
- UCD Centre for Interdisciplinary Research, Education & Innovation in Health Systems, School of Nursing, Midwifery & Health Systems UCD Health Sciences Centre, D04 VIW8 Dublin, Ireland; (S.P.T.)
| | - Brendan O’Daly
- Beacon Hospital, Beacon Court, Bracken Rd, Sandyford Business Park, Sandyford, D18 AK68 Dublin, Ireland
| | - Ailish Daly
- Beacon Hospital, Beacon Court, Bracken Rd, Sandyford Business Park, Sandyford, D18 AK68 Dublin, Ireland
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McNamara M, Ward M, Teeling SP. Making a Sustainable Difference to People, Processes and Systems: Whole-Systems Approaches to Process Improvement in Health Systems. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5232. [PMID: 37047849 PMCID: PMC10093971 DOI: 10.3390/ijerph20075232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 06/19/2023]
Abstract
The eighteen papers in this Special Issue, 'Whole-Systems Approaches to Process Improvement in Health Systems', address an enduring challenge in healthcare: to improve efficiency with existing or reduced resources, while maintaining safe and effective care [...].
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Affiliation(s)
- Martin McNamara
- UCD Centre for Interdisciplinary Research, Education & Innovation in Health Systems, UCD School of Nursing, Midwifery & Health Systems, UCD Health Sciences Centre, University College Dublin, Belfield, D04 V1W8 Dublin, Ireland;
| | - Marie Ward
- Centre for Innovative Human Systems, School of Psychology, Trinity College, The University of Dublin, D02 PN40 Dublin, Ireland;
| | - Seán Paul Teeling
- UCD Centre for Interdisciplinary Research, Education & Innovation in Health Systems, UCD School of Nursing, Midwifery & Health Systems, UCD Health Sciences Centre, University College Dublin, Belfield, D04 V1W8 Dublin, Ireland;
- Centre for Person-Centred Practice Research, Division of Nursing, School of Health Sciences, Queen Margaret University, Musselburgh EH21 6UU, UK
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Das A, Khan DZ, Hanrahan JG, Marcus HJ, Stoyanov D. Automatic generation of operation notes in endoscopic pituitary surgery videos using workflow recognition. INTELLIGENCE-BASED MEDICINE 2023; 8:100107. [PMID: 38523618 PMCID: PMC10958393 DOI: 10.1016/j.ibmed.2023.100107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/20/2023] [Accepted: 07/27/2023] [Indexed: 03/26/2024]
Abstract
Operation notes are a crucial component of patient care. However, writing them manually is prone to human error, particularly in high pressured clinical environments. Automatic generation of operation notes from video recordings can alleviate some of the administrative burdens, improve accuracy, and provide additional information. To achieve this for endoscopic pituitary surgery, 27-steps were identified via expert consensus. Then, for the 97-videos recorded for this study, a timestamp of each step was annotated by an expert surgeon. To automatically determine whether a step is present in a video, a three-stage architecture was created. Firstly, for each step, a convolution neural network was used for binary image classification on each frame of a video. Secondly, for each step, the binary frame classifications were passed to a discriminator for binary video classification. Thirdly, for each video, the binary video classifications were passed to an accumulator for multi-label step classification. The architecture was trained on 77-videos, and tested on 20-videos, where a 0.80 weighted-F1 score was achieved. The classifications were inputted into a clinically based predefined template, and further enriched with additional video analytics. This work therefore demonstrates automatic generation of operative notes from surgical videos is feasible, and can assist surgeons during documentation.
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Affiliation(s)
- Adrito Das
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, United Kingdom
| | - Danyal Z. Khan
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, United Kingdom
- National Hospital for Neurology and Neurosurgery, University College London, United Kingdom
| | - John G. Hanrahan
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, United Kingdom
- National Hospital for Neurology and Neurosurgery, University College London, United Kingdom
| | - Hani J. Marcus
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, United Kingdom
- National Hospital for Neurology and Neurosurgery, University College London, United Kingdom
| | - Danail Stoyanov
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, United Kingdom
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Daly A, Teeling SP, Garvey S, Ward M, McNamara M. Using a Combined Lean and Person-Centred Approach to Support the Resumption of Routine Hospital Activity following the First Wave of COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052754. [PMID: 35270447 PMCID: PMC8910100 DOI: 10.3390/ijerph19052754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/19/2022] [Accepted: 02/23/2022] [Indexed: 11/16/2022]
Abstract
The unexpected advent of the COVID-19 pandemic led to a sudden disruption of routine medical care, with a subsequent reorganization of hospital structures and of care. Case studies are becoming available in the literature referring to the logistical difficulties involved in a hospital resuming normal activity following the first COVID-19 lockdown period. This paper details the experience of a study site, a private hospital in Dublin, Ireland, in the redesign of service delivery in compliance with new COVID-19 prevention regulations to facilitate the resumption of routine hospital activity following the first wave of COVID-19. The aim was to resume routine activity and optimize patient activity, whilst remaining compliant with COVID-19 guidelines. We employed a pre-/post-intervention design using Lean methodology and utilised a rapid improvement event (RIE) approach underpinned by person-centred principles. This was a system-wide improvement including all hospital staff, facilitated by a specific project team including the chief operation officer, allied therapy manager (encompassing health and social care professionals), infection prevention and control team, head of surgical services, clinical nurse managers, patient services manager and the head of procurement. Following our intervention, hospital services resumed successfully, with the initial service resumption meeting the organizational target of a 75% bed occupancy rate, while the number of resumed surgeries exceeded the target by 13%. Our outpatient visits recovered to exceed the attendance numbers pre-COVID-19 in 2019 by 10%. In addition, patient satisfaction improved from 93% to 95%, and importantly, we had no in-hospital patient COVID-19 transmission in the study period of July to December 2020.
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Affiliation(s)
- Ailish Daly
- Beacon Hospital, Beacon Court, Bracken Road, Sandyford Business Park, Sandyford, Dublin 18, D18 AK68 Dublin, Ireland;
- Correspondence:
| | - Sean Paul Teeling
- UCD Centre for Interdisciplinary Research, Education & Innovation in Health Systems, Midwifery & Health Systems, UCD Health Sciences Centre, School of Nursing, D04 V1W8 Dublin, Ireland; (S.P.T.); (M.M.)
- Centre for Person-Centred Practice Research, Division of Nursing, School of Health Sciences, Queen Margaret University, Musselburgh EH21 6UU, UK
| | - Suzanne Garvey
- Beacon Hospital, Beacon Court, Bracken Road, Sandyford Business Park, Sandyford, Dublin 18, D18 AK68 Dublin, Ireland;
| | - Marie Ward
- Centre for Innovative Human Systems, School of Psychology, Trinity College, The University of Dublin, D02 PN40 Dublin, Ireland;
| | - Martin McNamara
- UCD Centre for Interdisciplinary Research, Education & Innovation in Health Systems, Midwifery & Health Systems, UCD Health Sciences Centre, School of Nursing, D04 V1W8 Dublin, Ireland; (S.P.T.); (M.M.)
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Moffatt S, Garry C, McCann H, Teeling SP, Ward M, McNamara M. The Use of Lean Six Sigma Methodology in the Reduction of Patient Length of Stay Following Anterior Cruciate Ligament Reconstruction Surgery. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1588. [PMID: 35162610 PMCID: PMC8835068 DOI: 10.3390/ijerph19031588] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 02/04/2023]
Abstract
Background: The purpose of this study was to reduce the length of stay of anterior cruciate ligament reconstruction patients within a private hospital in Ireland, reducing any non-value-added activity in the patient pathway, with the goal of increasing patient flow, bed capacity, and revenue generation within the hospital system, while maintaining patient satisfaction. Methods: We used a pre-/post-intervention design and Lean Six Sigma methods and tools to assess and improve the current process. Results: A reduction in inpatient length of stay by 57%, and a reduction in identified non-value-added activity by 88%, resulted in a new day-case surgery pathway for anterior cruciate ligament reconstruction patients. The pathway evidenced no re-admissions and demonstrated patient satisfaction. Conclusion: Six months post-project commencement, we had successfully achieved our goals of reducing our anterior cruciate ligament reconstruction patient's length of stay. This study contributes to the growing body of published evidence which shows that adopting a Lean Six Sigma approach can be successfully employed to optimise care and surgical pathways in healthcare.
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Affiliation(s)
- Sinead Moffatt
- Beacon Hospital, Beacon Court, Bracken Rd, Sandyford Business Park, Sandyford, Dublin 18, D18 AK68 Dublin, Ireland; (C.G.); (H.M.)
| | - Catherine Garry
- Beacon Hospital, Beacon Court, Bracken Rd, Sandyford Business Park, Sandyford, Dublin 18, D18 AK68 Dublin, Ireland; (C.G.); (H.M.)
| | - Hannah McCann
- Beacon Hospital, Beacon Court, Bracken Rd, Sandyford Business Park, Sandyford, Dublin 18, D18 AK68 Dublin, Ireland; (C.G.); (H.M.)
| | - Sean Paul Teeling
- UCD Centre for Interdisciplinary Research, Education & Innovation in Health Systems, School of Nursing, Midwifery & Health Systems UCD Health Sciences Centre, D04 V1W8 Dublin, Ireland; (S.P.T.); (M.M.)
- Centre for Person-Centred Practice Research Division of Nursing, School of Health Sciences, Queen Margaret University, Queen Margaret University Drive, Musselburgh EH21 6UU, UK
| | - Marie Ward
- Centre for Innovative Human Systems, School of Psychology, Trinity College, The University of Dublin, Dublin 2, D02 PN40 Dublin, Ireland;
| | - Martin McNamara
- UCD Centre for Interdisciplinary Research, Education & Innovation in Health Systems, School of Nursing, Midwifery & Health Systems UCD Health Sciences Centre, D04 V1W8 Dublin, Ireland; (S.P.T.); (M.M.)
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A Case Study of a Whole System Approach to Improvement in an Acute Hospital Setting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031246. [PMID: 35162269 PMCID: PMC8835196 DOI: 10.3390/ijerph19031246] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 11/16/2022]
Abstract
Changes in healthcare tend to be project-based with whole system change, which acknowledges the interconnectedness of socio-technical factors, not the norm. This paper attempts to address the question of whole system change posed by the special issue and brings together other research presented in this special issue. A case study approach was adopted to understand the deployment of a whole system change in the acute hospital setting along four dimensions of a socio-technical systems framework: culture, system functioning, action, and sense-making. The case study demonstrates evidence of whole system improvement. The approach to change was co-designed by staff and management, projects involving staff from all specialities and levels of seniority were linked to each other and to the strategic objectives of the organisation, and learnings from first-generation projects have been passed to second and third-generation process improvements. The socio-technical systems framework was used retrospectively to assess the system change but could also be used prospectively to help healthcare organisations develop approaches to whole system improvement.
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