Sustainability and Kaizen: Business Model Trends in Healthcare

Decoding the persistence of delayed hospital discharge: An in-depth scoping review and insights from two decades

OBJECTIVE

This article addresses the persistent challenge of Delayed Hospital Discharge (DHD) and aims to provide a comprehensive overview, synthesis, and actionable, sustainable plan based on the synthesis of the systematic review articles spanning the past 24 years. Our research aims to comprehensively examine DHD, identifying its primary causes and emphasizing the significance of effective communication and management in healthcare settings.

METHODS

We conducted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) method for synthesizing findings from 23 review papers published over the last two decades, encompassing over 700 studies. In addition, we employed a practical and comprehensive framework to tackle DHD. Rooted in Linderman's model, our approach focused on continuous process improvement (CPI), which highlights senior management commitment, technical/administrative support, and social/transitional care. Our proposed CPI method comprised several stages: planning, implementation, data analysis, and adaptation, all contributing to continuous improvement in healthcare delivery. This method provided valuable insights and recommendations for addressing DHD challenges.

FINDINGS

Our DHD analysis revealed crucial insights across multiple dimensions. Firstly, examining causes and interventions uncovered issues such as limited discharge destinations, signaling unsustainable solutions, and inefficient care coordination. The second aspect explored the patient and caregiver experience, emphasizing challenges linked to staff uncertainty and negative physical environments, with notable attention to the underexplored area of caregiver experience. The third theme explored organizational and individual factors, including cognitive impairment and socioeconomic influences. The findings emphasized the importance of incorporating patients' data, recognizing its complexity and current avoidance. Finally, the role of transitional and social care and financial strategies was scrutinized, emphasizing the need for multicomponent, context-specific interventions to address DHD effectively.

CONCLUSION

This study addresses gaps in the literature, challenges prevailing solutions, and offers practical pathways for reducing DHD, contributing significantly to healthcare quality and patient outcomes. The synthesis introduces the vital CPI stage, enhancing Linderman's work and providing a pragmatic framework to eradicate delayed discharge. Future efforts will address practitioner consultations to enhance perspectives and further enrich the study.

PATIENT OR PUBLIC CONTRIBUTION

Our scoping review synthesizes and analyzes existing systematic review articles and emphasizes offering practical, actionable solutions. While our approach does not directly engage patients, it strategically focuses on extracting insights from the literature to create a CPI framework. This unique aspect is intentionally designed to yield tangible benefits for patients, service users, caregivers, and the public. Our actionable recommendations aim to improve hospital discharge processes for better healthcare outcomes and experiences. This detailed analysis goes beyond theoretical considerations and provides a practical guide to improve healthcare practices and policies.

Evolution and trends of hikikomori: a bibliometrics analysis

Hikikomori is the Japanese term for the phenomenon of young adults isolating themselves from society and becoming reclusive. This study aims to examine the evolution and distribution of hikikomori, as well as identify the major players and institutions involved in hikikomori research. The searches, which were conducted in Scopus database identified 286 academic research works pertaining to hikikomori research. The findings indicate that hikikomori has attracted the attention of academic researchers in both the East and the West, with a consistent increase in research output since the Internet revolution over the past decade. The study highlights the potential for additional research on hikikomori and provides a benchmark for new researchers entering the field.

A scientometric review of hotspots and emerging trends in sustainable business model

A sustainable business model (SBM) has become an inevitable trend for the traditional business model to follow the development of the times. Based on scientometrics, we explored and visually analyzed SBM's hotspots and emerging trends using the references co-citation networks, landmark references, burst references, keywords co-occurring networks, timeline map, and burst keywords indicators. Our findings consist of four aspects: hotspots and emerging trends, hotspots evolution history, landmark references, and burst references evolution history. First, the core hotspots are "sustainable innovation" and "open innovation". Second, the main hotspots have evolved from "sustainable innovation," "strategy," "performance," and "supply chain" from 1998 to 2012 into "resource-based view," "product-service system," "China," "life cycle assessment," and "conceptual framework" in 2013-2017. And "circular economy," "renewable energy," "value creation," "decarbonization" have appeared since 2019, which are emerging trends of SBM. Third, we have found ten landmark references in total. Articles written by Bocken & Short, Boons & Ludeke-Freund, and Zott & Amit are the three most landmark references that significantly impact the whole field. Last, the top 10 cited references have burst since 2011 and lasted until 2022. The article written by Teece became a long-term cited hotspot from 2011 to 2018. Moreover, the article written by Geissdoerfer & Vladimirova, which burst in 2020-2022, was the most cutting-edge. This research aims to enrich the existing research theories related to SBM and help governments and enterprises capture hotspots and emerging trends of SBM so that they can better understand and study SBM.

Effect of lean manufacturing tools on sustainability: the case of Mexican maquiladoras

The Mexican maquiladora industry is applying Lean Manufacturing Tools (LMT) in its production lines; however, few studies have investigated its relationship with sustainability (social, economic, and environmental). This paper presents a second-order structural equation model (SEM) relating 8 LMT integrated into three independent latent variables: continuous improvement (Kaizen and Gemba), supporting tools (Andon, visual management, and Poka-yoke), and machinery and equipment (total productive maintenance, overall equipment effectiveness, and Jidoka) that are related to social, economic, and environmental sustainability as dependent variables. The model is validated with information obtained from 249 companies using partial least squares. Findings show that the application of LMT in the Mexican maquiladora industry avoids the generation of waste and reprocessing. Likewise, the improvement of production processes reduces the waste emitted into the environment and reduces energy consumption. Also, when companies have environmental programs, the work environment is safe, and labor relations are improved, increasing morale and the commitment to work for the company, gaining economic and ecological benefits.

A Model for the Implementation of Lean Improvements in Healthcare Environments as Applied in a Primary Care Center

Companies operate in a competitive and changing environment requiring increasingly effective and efficient management strategies. Lean is a proven philosophy in the industrial sector having helped companies to adapt to rapid market changes; to economic, technical, and social complexities; and to customer needs. For this reason, companies in the service sector are adopting Lean to improve their service management and to achieve economic, social, and environmental sustainability. This paper presents a model which uses Lean tools to facilitate the introduction of Lean in the management of primary care centers. The results show the implementation of Lean improved primary care center management, achieved stated objectives, and demonstrated faster adaptation to environmental needs and changes. The Lean philosophy developed and applied in the primary care center proved useful at a professional level facilitating developmental changes and prompting lasting improvements by developing a sustainable work culture.