Continuous improvement projects: an authorship bibliometric analysis

Sustainability of performance improvements after 26 Kaizen events in a large academic hospital system: a mixed methods study

INTRODUCTION

Implementing Kaizen can improve productivity in healthcare but maintaining long-term results has proven challenging. This study aimed to assess improved performance achieved and sustained by Kaizen events and find explanatory factors for the persistence or decline of long-term results.

METHODS

Kaizen events were conducted in 26 specialised healthcare units in a large academic hospital system in southern Finland. Primary data for mixed methods analysis was collected from each unit with 21 semi-structured interviews, Kaizen report files and performance metrics.

RESULTS

Fifteen explanatory factors were found in this study. Work culture and motivation for continuous improvement stood out as the most important explanatory factor for the persistence of long-term results-lack of time for improvement activities and high workload for the decline. Success in preparation and follow-up was associated with sustained long-term results. Thirteen units achieved long-term results, three units could not sustain the performance improvements and five units struggled to make any improvements.

CONCLUSIONS

This study explains the long-term sustainability of performance improvements, bringing new insights to Kaizen research. Our findings can guide organising successful Kaizen events. The events can be worth organising even though long-term performance improvements are not guaranteed. Units with supportive working culture and motivation for the Kaizen event will likely succeed. A unit should aim to create a supportive foundation for Kaizen before organising a Kaizen event. Units that lack the foundation can be identified, trained and guided to increase their chances of success. Pitfalls like high workload and insufficient follow-up should be proactively identified and appropriately managed by allocating the required time and resources for the development work.

Lean six-sigma (LSS) applications in hospitals: a decade (2011–2020) bibliometric analysis

Purpose

This study examines the research landscape of Lean Six-Sigma (LSS) applications in hospitals for the period of the last decade (2011–2020) to derive answers to the research questions RQ 1: What are the current publication trends for the application of LSS in hospitals concerning document type, Journal (Source), active authors and country-wise publications and their comparison in the two most reputed scientific databases, i.e. Scopus and Web of Science (WoS), RQ2: What are the clusters based on the authors and keywords? RQ3: What are the research trends and author's productivity in LSS applications in Hospitals? RQ4: What are the future research areas?

Design/methodology/approach

This article compares these two databases (Scopus and WoS) based on publication pattern, document type, active authors and co-citation analysis. This article analyzes the core sources, author's productivity, globally cited articles, word growth analysis, thematic map and world collaboration map on the WoS and Scopus dataset. The software used are Vosviewer, Biblioshiny (R Package for Bibliometric) and M.S. Excel.

Findings

The application of LSS in hospitals is a niche theme. In the WoS database International Journal of Lean Six-Sigma and in Scopus database International Journal of Health Care Quality Assurance are the most relevant sources publishing research articles in this field. The USA has the highest scientific production in this field. Among the authors, Antony J is the most active author in this area, with the highest contribution over the years.

Originality/value

This study fills the literature gap by mapping the field of LSS in hospitals.

Preventing dispensing errors through the utilization of lean six sigma and failure model and effect analysis: A prospective exploratory study in China

AIMS

To utilize lean six sigma (LSS) and failure model and effect analysis (FMEA) to prevent dispensing errors in a Chinese teaching hospital.

METHODS

Medication errors (MEs) reported to the China Core Group of the international network for the rational use of drugs (INRUD) by pharmacists at the hospital were collected. Following LSS methodology, the data analysis was structured according to define, measure, analyse, improve, and control (DMAIC) phases, and typical LSS tools (Pareto diagrams, brainstorming sessions) were used to determine the risk factors leading to dispensing errors. FMEA was applied to generate the risk priority numbers (RPNs) of MEs events, and key medications targeted for error prevention strategies were identified through quantitative analysis of the impacts of failure. Finally, corrective measures to prevent MEs were implemented and monitored for efficacy.

RESULTS

Before the implementation of this programme, a total of 603 cases of dispensing errors were reported from the Year 1 to Year 6, reaching an average rate of incidence of 0.33 cases per 10 000 medication orders delivered, and no difference was found between these years (P = .9424). There was also no difference as location, error type, contributing factors, cause classification were considered. We then determined the real cause behind dispensing errors, and a total of 67 medications were targeted for specific error prevention strategies. One year after intervention, progress had been achieved in the following aspects: the incidence rate of dispensing errors was significantly decreased compared with the previous years (0.19, P = .007). Simultaneously, the incidence rate of dispensing errors occurred in outpatient pharmacy (0.04, P = .0008), with junior pharmacists (0.15, P = .0258), with LASA medications (0.06, P = .0319), as well as with memory-based errors were significantly decreased (0.03, P = .0191).

CONCLUSION

The combination of LSS and the FMEA tool can be an efficient approach for helping reduce MEs in pharmacy dispensing.

Improvement project in higher education institutions: A BPEP-based model

Improvement projects (IPs) are a fundamental element in any quality management system from any organization. In Higher Education Institutions (HEIs), IPs are constantly implemented to maintain excellence in academic and administrative processes. In this study, we propose a model for IP implementation that is based on the Baldrige Performance Excellence Program (BPEP). As a part of the model, we propose a series of research hypotheses to be tested. The data used to test the hypotheses were gathered from a questionnaire that was developed after an extensive literature review. The survey was administered to Mexican public HEIs, and more than 700 responses were collected. The data were assessed in terms of convergent and discriminant validity, obtaining satisfactory results. To test the proposed relationships between the model constructs, we utilized Structural Equation Modeling (SEM) using the software IBM SPSS Amos. The analysis confirmed the statistical validity of both the model and the hypotheses. In conclusion, our model for IP implementation is a useful tool for HEIs that seek to attain excellence in their processes through IPs.

An exploratory study into the use of Lean Six Sigma to reduce medication errors in the Norwegian public healthcare context

PURPOSE

Medication errors are a significant cause of injury in Norwegian hospitals. The purpose of this study is to explore how Lean Six Sigma (LSS) has been used in the Norwegian public health-care context to reduce medication errors.

DESIGN/METHODOLOGY/APPROACH

A mixed method approach was used to gather data from participants working in the four regions served by the Norway health authorities. A survey questionnaire was distributed to 38 health-care practitioners and semi-structured interviews were conducted with 12 health-care practitioners.

FINDINGS

The study finds that the implementation of LSS in the Norwegian public health-care context is still in its infancy. This is amidst several challenges faced by Norwegian hospitals such as the lack of top-management support, lack of LSS training and coaching and a lack of awareness around the benefits of LSS in health care.

RESEARCH LIMITATIONS/IMPLICATIONS

Because of the large geographical area, it was difficult to reach participants from all health regions in Norway. However, the study managed to assess the current status of LSS implementation through the participants' perspectives. This is a fruitful area for future research whereby an action research methodology could be used.

ORIGINALITY/VALUE

To the best of the authors' knowledge, this is the first empirical study into the use of LSS methodology in reducing medication errors. In addition, this study is valuable for health-care practitioners and professionals as a guideline to achieve the optimal benefit of LSS implementation to reduce medication errors.

Reducing errors in the administration of medication with infusion pumps in the intensive care department: A lean approach

Background:

Medication errors occur frequently and may potentially harm patients. Administering medication with infusion pumps carries specific risks, which lead to incidents that affect patient safety.

Objective:

Since previous attempts to reduce medication errors with infusion pumps failed in our intensive care unit, we chose the Lean approach to accomplish a 50% reduction of administration errors in 6 months. Besides improving quality of care and patient safety, we wanted to determine the effectiveness of Lean in healthcare.

Methods:

We conducted a before-and-after observational study. After baseline measurement, a value stream map (a detailed process description, used in Lean) was made to identify important underlying causes of medication errors. These causes were discussed with intensive care unit staff during frequent stand-up sessions, resulting in small improvement cycles and bottom-up defined improvement measures. Pre-intervention and post-intervention measurements were performed to determine the impact of the improvement measures. Infusion pump syringes and related administration errors were measured during unannounced sequential audits.

Results:

Including the baseline measurement, 1748 syringes were examined. The percentage of errors concerning the administration of medication by infusion pumps decreased from 17.7% (95% confidence interval, 13.7–22.4; 55 errors in 310 syringes) to 2.3% (95% confidence interval, 1–4.6; 7 errors in 307 syringes) in 18 months (p < 0.0001).

Conclusion and Relevance:

The Lean approach proved to be helpful in reducing errors in the administration of medication with infusion pumps in a high complex intensive care environment.

Continuous improvement project within Kaizen: critical success factors in hospitals

Purpose

Evidence suggests that hospitals are having problems achieving continuous improvement project (CIP) goals or sustaining their results. Therefore, the purpose of this paper is to identify those critical success factors (CSFs) most strongly related to CIP success in hospitals (Lean-Kaizen project, Lean Six Sigma project, Six Sigma projects, and Quality Improvement projects).

Design/methodology/approach

A retrospective survey was applied to any CIP leaders/facilitators from hospitals that conducted at least one CIP during the last two years.

Findings

Three main findings were obtained from the 116 valid responses. First, the level of importance of 47 out of 53 CSFs to achieve CIPs success in hospitals was assessed as very important or higher (4 or higher on a six-point scale). Second, there are important differences between the CSFs to achieve CIP success in hospitals in this research and previous investigations. Third, the type of CIP affects the level of importance of 16 out of 53 CSFs to achieve CIP success in hospitals.

Originality/value

Practitioners involved with CIPs activities in hospitals could use the knowledge extracted from this investigation to improve the impact of their CIPs. Future research should continue in two lines: test if the 53 CSFs for CIPs measure a unique factor and identify the main relationships or paths between CSFs for CIPs and CIP outcomes.

The best of both worlds? Use of Kaizen and other continuous improvement methodologies within Portuguese ISO 9001 certified organizations

Purpose

ISO 9001:2015 edition, by adopting modern management and quality approaches, can foster the application of continuous improvement (CI) methodologies. The purpose of this paper is to assess the level of utilization of Kaizen and other CI methodologies within Portuguese ISO 9001 certified organizations, namely, amid organizations that have already implemented ISO 9001:2015.

Design/methodology/approach

After the literature review, a quantitative research, supported on an online survey, was adopted. The survey yielded 309 valid responses (response rate 18 percent) encompassing 71 organizations already certified against ISO 9001:2015 and the remaining 238 against ISO 9001:2008. The results of the statistical analysis performed were reviewed with a focus group of five quality and organizational excellence managers.

Findings

The results show a mildly use of Kaizen, Lean and Six Sigma (SS) by Portuguese ISO 9001 certified organizations, which is increase when compared to previous studies. The sample of organizations that are already certified by ISO 9001:2015 have mean and median levels of customer improvement methodologies adoption (Lean, Kaizen, SS) higher than those that are still certified against ISO 9001:2008. However, the Kruskal-Wallis test showed that these differences are not statistically significant. Concerning the adoption of these methodologies by activity sector, the sample median values seem to suggest that Lean and SS are more commonly adopted in the industry than in the services, but according to the Kruskal-Wallis test these differences are not statistically significant. Checklists, plan-do-check-act cycle and process diagrams, followed by DMAIC, are the quality tools that are most frequently adopted. A high workload due to the transition process for ISO 9001:2015 and the lack of qualified people were suggested as possible explanations for these results by the Expert Focus Group.

Research limitations/implications

The study is restricted to ISO 9001 certified organizations in Portugal and due to the short time since ISO 9001:2015 implementation it should be considered as having an explanatory nature and subject to future confirmation.

Originality/value

This study on the application of CI methodologies between ISO 9001:2015 and ISO 9001:2008 certified organizations contributes to the Kaizen and CI body of knowledge and provides inputs to the organizations and professionals that aim to successfully apply it.