Lean Improvement Practices: Lessons from Healthcare Service Delivery Chains

Evaluation of critical operations capabilities for competitive manufacturing in a high-cost environment

Purpose

To survive in a competitive landscape, companies are required to identify, develop and continuously improve upon the operations capabilities that have the greatest impact on the overall competitiveness. This paper aims to evaluate critical operations capabilities for competitive manufacturing in a high-cost environment.

Design/methodology/approach

Critical operations capabilities for competitive manufacturing were extracted in a literature review and then evaluated from the perspective of a high-cost environment in a focus group study. The focus group included a quantitative (questionnaire) and qualitative (discussion) evaluation of the extracted critical operations capabilities.

Findings

The empirical findings revealed that all the capabilities identified in the literature review are considered critical in a high-cost environment, albeit with varying emphasis. Companies located in a high-cost environment tend to emphasize a broad set of capabilities related to quality, cost, time, flexibility and innovation rather than only cost-related capabilities.

Research limitations/implications

The research is based on a focus group that was limited to 14 representatives from five Swedish manufacturing companies. This can reveal some limitations with regard to the generalizability of the conclusions drawn. Hence, this research should be considered as an initial step in gaining a more in-depth and complete understanding of the research topic under investigation.

Practical implications

The research outcome enables managers to design their operations strategy more systematically and effectively, to be consistent with their targeted capabilities. The operations capabilities are important for both the company’s competitiveness and its future direction.

Originality/value

The paper presents an updated understanding of how companies achieved a competitive advantage in a specific manufacturing environment such as a high-cost context. It additionally provides an overview of what capabilities are developed for implementing successful operations strategies.

Multi-stage Screening in Early Intervention: A Critical Strategy for Improving ASD Identification and Addressing Disparities

Health disparities in ASD detection affect children's access to subsequent interventions. We examined potential disparities in implementation of a multi-stage ASD screening and diagnostic evaluation protocol in Part C Early Intervention with 4943 children ages 14-36 months (mean 22.0 months; 62.9% boys, 73.3% children of color, 34.9% non-English-primary language, 64.5% publicly-insured). Participation and follow-through were high (64.9% and 65.3% at first- and second-stage screening, respectively, 84.6% at diagnostic evaluation). Logistic regressions identified predictors of screening participation and outcomes at each stage; demographic differences (race, language, public insurance) were observed only at first-stage screening and reflected higher participation for children of color and higher positive screens for publicly-insured children. Results suggest the multi-stage screening protocol shows promise in addressing disparities in early diagnosis.

Business process improvement methods in healthcare: a comparative study

PURPOSE

According to the literature concerned with this study, less than satisfactory outcomes have been achieved through implementing business process improvements methods (BPIMs) in industries, in general, and in healthcare, in particular. The existing methods used need to be enhanced in order to create more effective outcomes. There has also been a lack of studies documenting gaps or shortfalls in implementing BPIMs, to be presented to the BPI research community. Therefore, researchers of this paper have attempted to fill gaps between theory and practice. On the contrary, there is also a need to link practical outcomes in the healthcare domain with those of the BPI research community. The purpose of this paper is to review popular BPIMs, techniques and tools applied in the healthcare domain; it seeks to examine and highlight their significant roles, clarify their pros and cons, and find opportunities to enhance their impact on the achievement of more sustainable improvements in the healthcare domain.

DESIGN/METHODOLOGY/APPROACH

This study has been carried out by using a methodology combining an in-depth literature review with a comparison framework, which is called as the "Framework for Comparing Business Process Improvement Methods." The framework is composed of seven dimensions and has been adapted from four recognized, related frameworks. In addition to the in-depth review of related literature and the adapted comparison framework, researchers have conducted several interviews with healthcare BPI practitioners in different hospitals, to attain their opinions of BPI methods and tools used in their practices.

FINDINGS

The main results have indicated that significant improvements have been achieved by implementing BPIMs in the healthcare domain according to related literature. However, there were some shortfalls in the existing methods that need to be resolved. The most important of these has been the shortfall in representing and analyzing targeted domain knowledge during improvement phases. The tool currently used for representing the domain, specifically flowcharts, is very abstract and does not present the domain in a clear form. The flowchart tool also fails to clearly present the separation of concerns between business processes and the information systems processes that support a business in a given domain.

PRACTICAL IMPLICATIONS

The findings of this study can be useful for BPI practitioners and researchers, mainly within the healthcare domain. The findings can help these groups to understand BPIMs shortfalls and encourage them to consider how BPIMs can be potentially improved.

ORIGINALITY/VALUE

This researchers of this paper have proposed a comparison framework for highlighting popular BPIMs in the healthcare domain, along with their uses and shortfalls. In addition, they have conducted a deep literature review based on the practical results obtained from different healthcare institutions implementing unique BPIMs around the world. There has also been valuable interview feedback attained from BPI leaders of specific hospitals in Saudi Arabia. This combination is expected to contribute to knowledge of BPIMs from both theoretical and practical points of view.

A systematic literature review of healthcare supply chain and implications of future research

Purpose

This paper aims to review the healthcare supply chain (HSC) literature along various areas and to find out the gap in it.

Design/methodology/approach

In total, 143 research papers were reviewed during 1996-2017. A critical review was carried out in various dimensions such as research methodologies/data collection method (empirical, case study and literature review) and inquiry mode of research methodology (qualitative, quantitative and mixed), country-specific, targeted area, research aim and year of publication.

Findings

Supply chain (SC) operations, performance measurement, inventory management, lean and agile operation, and use of information technology were well studied and analyzed, however, employee and customer training, tracking and visibility of medicines, cold chain management, human resource practices, risk management and waste management are felt to be important areas but not much attention were made in this direction.

Research limitations/implications

Mainly drug and vaccine SC were considered in current study of HSC while SC along healthcare equipment and machine, hospitality and drug manufacturing related papers were excluded in this study.

Practical implications

This literature review has recognized and analyzed various issues relevant to HSC and shows the direction for future research to develop an efficient and effective HSC.

Originality/value

The insight of various aspects of HSC was explored in general for better and deeper understanding of it for designing of an efficient and competent HSC. The outcomes of the study may form a basis to decide direction of future research.

A systematic review of Lean in healthcare: a global prospective

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).