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Hilverda JJ, Roemeling O, Smailhodzic E, Aij KH, Hage E, Fakha A. Unveiling the Impact of Lean Leadership on Continuous Improvement Maturity: A Scoping Review. J Healthc Leadersh 2023; 15:241-257. [PMID: 37841810 PMCID: PMC10576566 DOI: 10.2147/jhl.s422864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/29/2023] [Indexed: 10/17/2023] Open
Abstract
Purpose Lean Management (LM) is a process improvement approach with growing interest from healthcare organizations. Obtaining a culture of continuous improvement is a primary objective of LM, and a culture of continuous improvement indicates a mature LM approach, and here leadership plays a central role. However, a comprehensive overview of leadership activities influencing LM maturity is lacking. This study aims to identify leadership activities associated with continuous improvement and, thus, LM, maturity. Methods Following the PRISMA guidelines, a scoping literature review of peer-reviewed articles was conducted in twenty healthcare management journals. The search provided 466 articles published up until 2023. During the selection process, 23 studies were included in the review. The leadership activities related to continuous improvement maturity were identified using the grounded theory approach and data coding. Results The analysis highlighted a total of 58 leadership activities distributed across nine themes of LM leadership. Next, analysing leadership activities concerning the different maturity levels revealed three maturity stages: beginner, intermediate, and expert. Based on the findings, we propose a framework that guides suitable leadership activities at the various stages of LM maturity. The framework provides leaders in healthcare with a practical overview of actions to facilitate the growth of the LM approach, and the related propositions offer academics a theoretical basis for future studies. Conclusion This review presents the first comprehensive overview of LM leadership activities in relation to continuous improvement and LM maturity. To enhance LM maturity, leaders are encouraged to consider their leadership style, (clinical) stakeholder involvement, alignment with the organizational strategy, and their role in promoting employee autonomy.
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Affiliation(s)
- Jesse Jorian Hilverda
- Department of Audit & Risk Management, University Medical Center Groningen, Groningen, the Netherlands
| | - Oskar Roemeling
- Department of Innovation, Management & Strategy, University of Groningen, Groningen, the Netherlands
| | - Edin Smailhodzic
- Department of Innovation, Management & Strategy, University of Groningen, Groningen, the Netherlands
| | | | - Eveline Hage
- Department of Innovation, Management & Strategy, University of Groningen, Groningen, the Netherlands
| | - Amal Fakha
- Department of Innovation, Management & Strategy, University of Groningen, Groningen, the Netherlands
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Effects of Lean Interventions Supported by Digital Technologies on Healthcare Services: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159018. [PMID: 35897392 PMCID: PMC9330917 DOI: 10.3390/ijerph19159018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 12/31/2022]
Abstract
Despite the increasing utilization of lean practices and digital technologies (DTs) related to Industry 4.0, the impact of such dual interventions on healthcare services remains unclear. This study aims to assess the effects of those interventions and provide a comprehensive understanding of their dynamics in healthcare settings. The methodology comprised a systematic review following the PRISMA guidelines, searching for lean interventions supported by DTs. Previous studies reporting outcomes related to patient health, patient flow, quality of care, and efficiency were included. Results show that most of the improvement interventions relied on lean methodology followed by lean combined with Six Sigma. The main supporting technologies were simulation and automation, while emergency departments and laboratories were the main settings. Most interventions focus on patient flow outcomes, reporting positive effects on outcomes related to access to service and utilization of services, including reductions in turnaround time, length of stay, waiting time, and turnover time. Notably, we found scarce outcomes regarding patient health, staff wellbeing, resource use, and savings. This paper, the first to investigate the dual intervention of DTs with lean or lean–Six Sigma in healthcare, summarizes the technical and organizational challenges associated with similar interventions, encourages further research, and promotes practical applications.
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Antonacci G, Lennox L, Barlow J, Evans L, Reed J. Process mapping in healthcare: a systematic review. BMC Health Serv Res 2021; 21:342. [PMID: 33853610 PMCID: PMC8048073 DOI: 10.1186/s12913-021-06254-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 03/08/2021] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Process mapping (PM) supports better understanding of complex systems and adaptation of improvement interventions to their local context. However, there is little research on its use in healthcare. This study (i) proposes a conceptual framework outlining quality criteria to guide the effective implementation, evaluation and reporting of PM in healthcare; (ii) reviews published PM cases to identify context and quality of PM application, and the reported benefits of using PM in healthcare. METHODS We developed the conceptual framework by reviewing methodological guidance on PM and empirical literature on its use in healthcare improvement interventions. We conducted a systematic review of empirical literature using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology. Inclusion criteria were: full text empirical study; describing the process through which PM has been applied in a healthcare setting; published in English. Databases searched are: Medline, Embase, HMIC-Health Management Information Consortium, CINAHL-Cumulative Index to Nursing and Allied Health Literature, Scopus. Two independent reviewers extracted and analysed data. Each manuscript underwent line by line coding. The conceptual framework was used to evaluate adherence of empirical studies to the identified PM quality criteria. Context in which PM is used and benefits of using PM were coded using an inductive thematic analysis approach. RESULTS The framework outlines quality criteria for each PM phase: (i) preparation, planning and process identification, (ii) data and information gathering, (iii) process map generation, (iv) analysis, (v) taking it forward. PM is used in a variety of settings and approaches to improvement. None of the reviewed studies (N = 105) met all ten quality criteria; 7% were compliant with 8/10 or 9/10 criteria. 45% of studies reported that PM was generated through multi-professional meetings and 15% reported patient involvement. Studies highlighted the value of PM in navigating the complexity characterising healthcare improvement interventions. CONCLUSION The full potential of PM is inhibited by variance in reporting and poor adherence to underpinning principles. Greater rigour in the application of the method is required. We encourage the use and further development of the proposed framework to support training, application and reporting of PM. TRIAL REGISTRATION Prospero ID: CRD42017082140.
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Affiliation(s)
- Grazia Antonacci
- Department of Primary Care and Public Health, Imperial College London, National Institute of Health Research (NIHR) Applied Research Collaboration (ARC) Northwest London, London, UK
- Business School, Centre for Health Economics and Policy Innovation (CHEPI), Imperial College London, London, UK
| | - Laura Lennox
- Department of Primary Care and Public Health, Imperial College London, National Institute of Health Research (NIHR) Applied Research Collaboration (ARC) Northwest London, London, UK
| | - James Barlow
- Business School, Centre for Health Economics and Policy Innovation (CHEPI), Imperial College London, London, UK
| | - Liz Evans
- Department of Primary Care and Public Health, Imperial College London, National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Northwest London, London, UK
| | - Julie Reed
- Department of Primary Care and Public Health, Imperial College London, National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Northwest London, London, UK
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Tlapa D, Zepeda-Lugo CA, Tortorella GL, Baez-Lopez YA, Limon-Romero J, Alvarado-Iniesta A, Rodriguez-Borbon MI. Effects of Lean Healthcare on Patient Flow: A Systematic Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:260-273. [PMID: 32113632 DOI: 10.1016/j.jval.2019.11.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 11/01/2019] [Accepted: 11/14/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To assess the effects of lean healthcare (LH) on patient flow in ambulatory care and determine whether waiting time and length of stay (LOS) decrease after LH interventions. METHODS A systematic review was performed with close adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We searched for studies of healthcare organizations applying LH interventions within ambulatory care published between 2002 and 2018. Six databases and grey literature sources were used. Two reviewers independently screened and assessed each study. When consensus was difficult to reach, a third reviewer intervened. Finally, a summary of findings was generated. RESULTS Out of 5627 studies, 40 were included. Regarding LOS for all patients, 19 out of 22 studies reported a decrease. LOS for discharged patients decreased in 11 out of 13 studies, whereas LOS for admitted patients was reduced in 6 out of 7 studies. Waiting time for patients before seeing a healthcare professional decreased in 24 out of 26 studies. Waiting time to treatment and waiting time for appointments were minimized in 4 and 2 studies, respectively. Patients who left without being seen by a doctor decreased in 9 out of 12 studies. Finally, patient and staff satisfaction were measured in 8 and 2 studies, respectively, with each reporting improvements. CONCLUSIONS According to our findings, LH helped to reduce waiting time and LOS in ambulatory care, mainly owing to its focus on identifying and minimizing non-value added (NVA) activities. Nevertheless, evidence of the impact of LH on patient/staff satisfaction and the translation of the obtained benefits into savings is scarce among studies.
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Affiliation(s)
- Diego Tlapa
- Universidad Autónoma de Baja California, Ensenada, Baja California, Mexico.
| | | | | | | | - Jorge Limon-Romero
- Universidad Autónoma de Baja California, Ensenada, Baja California, Mexico
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Régis TKO, Santos LC, Gohr CF. A case-based methodology for lean implementation in hospital operations. J Health Organ Manag 2019; 33:656-676. [PMID: 31625821 DOI: 10.1108/jhom-09-2018-0267] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Although there are general methodologies for lean implementation in manufacturing companies, a specific methodology for the implementation of lean healthcare in hospitals has not been addressed by the literature. Addressing this gap, the purpose of this paper is to develop a practice-driven methodology for implementing lean in hospital operations. DESIGN/METHODOLOGY/APPROACH Three case studies were conducted to collect evidence on the lean implementation process in Brazilian hospitals. From empirical evidence and literature, the implementation methodology was proposed and submitted to critical assessment by experts from the field. FINDINGS The process of lean implementation was very similar in all cases, triggered by strategic planning and operationalized by continuous improvement projects. On the other hand, in all cases, the lean implementation teams had to deal with employees' resistance. These findings were valuable inputs to the development of the implementation methodology. After refinement, it was proposed a feasible, useful and user-friendly methodology. RESEARCH LIMITATIONS/IMPLICATIONS The proposed methodology was raised from the practice through case study research. However, the proposed methodology was not fully applied, and the associated performance measures were not elaborated in this paper. Therefore, more case studies and applications will be necessary to generalize the findings. PRACTICAL IMPLICATIONS The methodology provides practical guidelines that support lean implementation in hospital operations. Although it demands adaptations for each specific hospital setting, this initial step may encourage hospital managers to start the lean journey. ORIGINALITY/VALUE This study addressed the gap in the literature regarding the lack of methodologies for implementing lean healthcare in hospital operations. The methodology synthesizes the knowledge, principles and tools of lean thinking that can be applied in hospital operations.
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Rotter T, Plishka C, Lawal A, Harrison L, Sari N, Goodridge D, Flynn R, Chan J, Fiander M, Poksinska B, Willoughby K, Kinsman L. What Is Lean Management in Health Care? Development of an Operational Definition for a Cochrane Systematic Review. Eval Health Prof 2019; 42:366-390. [PMID: 29635950 PMCID: PMC6659584 DOI: 10.1177/0163278718756992] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Industrial improvement approaches such as Lean management are increasingly being adopted in health care. Synthesis is necessary to ensure these approaches are evidence based and requires operationalization of concepts to ensure all relevant studies are included. This article outlines the process utilized to develop an operational definition of Lean in health care. The literature search, screening, data extraction, and data synthesis processes followed the recommendations outlined by the Cochrane Collaboration. Development of the operational definition utilized the methods prescribed by Kinsman et al. and Wieland et al. This involved extracting characteristics of Lean, synthesizing similar components to establish an operational definition, applying this definition, and updating the definition to address shortcomings. We identified two defining characteristics of Lean health-care management: (1) Lean philosophy, consisting of Lean principles and continuous improvement, and (2) Lean activities, which include Lean assessment activities and Lean improvement activities. The resulting operational definition requires that an organization or subunit of an organization had integrated Lean philosophy into the organization's mandate, guidelines, or policies and utilized at least one Lean assessment activity or Lean improvement activity. This operational definition of Lean management in health care will act as an objective screening criterion for our systematic review. To our knowledge, this is the first evidence-based operational definition of Lean management in health care.
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Affiliation(s)
- Thomas Rotter
- Healthcare Quality Programs, School of Nursing, Queen's University,
Kingston, Canada
| | - Christopher Plishka
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon,
Canada
| | - Adegboyega Lawal
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon,
Canada
| | - Liz Harrison
- School of Rehabilitation Science, College of Medicine, University of
Saskatchewan, Saskatoon, Canada
| | - Nazmi Sari
- Department of Economics, University of Saskatchewan, Saskatoon, Canada
| | - Donna Goodridge
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Rachel Flynn
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - James Chan
- School of Health Sciences, University of Northern British Columbia,
Canada
| | - Michelle Fiander
- Assistant Research Professor, College of Pharmacy, Department of
Pharmacotherapy, University of Utah
| | - Bonnie Poksinska
- Department of Management and Engineering, Linköping University, Sweden
| | - Keith Willoughby
- Edwards School of Business, University of Saskatchewan, Saskatoon,
Canada
| | - Leigh Kinsman
- University of Tasmania and Tasmanian Health Service (North), Launceston,
Tasmania, Australia
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Drayton Jackson M, Bartman T, McGinniss J, Widener P, Dunn AL. Optimizing patient flow in a multidisciplinary haemophilia clinic using quality improvement methodology. Haemophilia 2019; 25:626-632. [PMID: 31144379 DOI: 10.1111/hae.13768] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 04/02/2019] [Accepted: 04/10/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Multidisciplinary clinics in academic settings are often inefficient and can lead to lengthy clinic visits for patients and staff. AIM We aimed to use quality improvement (QI) methodology and a multidisciplinary approach to optimize outpatient comprehensive haemophilia clinic flow. METHODS At baseline, a multidisciplinary QI team created a key driver diagram to identify drivers of haemophilia clinic flow. Identified drivers included patient needs/scheduling, provider flow and laboratory/research requirements. From December 2016 to August 2017, value stream mapping (VSM) was used to identify barriers to clinic flow, and plan-do-study-act cycles were used to address these barriers. Interventions included (a) standardizing the order in which providers saw patients to enable time-sensitive laboratories, (b) improving HTC team meeting functionality, (c) optimizing a visual management board and implementing a flow coordinator, (d) initiating a team huddle prior to clinic start and (e) modifying the clinic appointment template. Timely laboratory draw was used as a surrogate marker of clinic flow, and VSM utilization percentage was used as an objective measure of efficiency. RESULTS We did not demonstrate a statistically significant improvement in timed laboratory draws; however, clinic utilization percentage increased by 30%, which resulted in adding point-of-care musculoskeletal ultrasound services without lengthening clinic duration. CONCLUSION Quality improvement methodology is an effective means of improving clinic utilization in a multidisciplinary clinic.
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Affiliation(s)
- Meghan Drayton Jackson
- Riley Hospital for Children, Indiana University Health, Indianapolis, Indiana.,Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, Ohio
| | - Thomas Bartman
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio.,Quality Improvement Services, Nationwide Children's Hospital, Columbus, Ohio
| | - Jessica McGinniss
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, Ohio
| | - Pamela Widener
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, Ohio
| | - Amy L Dunn
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio
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Lee P, Pham L, Oakley S, Eng K, Freydin E, Rose T, Ruiz A, Reen J, Suleyman D, Altman V, Keating Bench K, Lee A, Mahaniah K. Using lean thinking to improve hypertension in a community health centre: a quality improvement report. BMJ Open Qual 2019; 8:e000373. [PMID: 30997412 PMCID: PMC6440610 DOI: 10.1136/bmjoq-2018-000373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 11/26/2018] [Accepted: 01/04/2019] [Indexed: 11/18/2022] Open
Abstract
Background Achieving better care at lower cost in the US healthcare safety net will require federally qualified health centres (FQHC) to implement new models of team-based population healthcare. Lean thinking may offer a way to reduce the financial risk of practice transformation while increasing the likelihood of sustained improvement. Objective To demonstrate system-level improvement in hypertension control in a large FQHC through the situational use of lean thinking and statistical process control. Setting Lynn Community Health Center, the third largest FQHC in Massachusetts, USA. Participants 4762 adult patients with a diagnosis of hypertension. Intervention First, we created an organisation-wide focus on hypertension. Second, we implemented a multicomponent hypertension care pathway. The lean tools of strategy deployment, standardised work, job instruction, Plan-Do-Study-Adjust, 5S and visual control were used to overcome specific obstacles in the implementation. Measurements The primary outcome was hypertension control, defined as last measured blood pressure <140/90. Statistical process control was used to establish baseline performance and assess special cause variation resulting from the two-step intervention. Results Hypertension control improved by 11.6% from a baseline of 66.8% to a 6 month average of 78.2%. Limitations Durability of system changes has not been demonstrated beyond the 14-month period of the intervention. The observed improvement may underestimate the effect size of the full hypertension care pathway, as two of the five steps have only been partially implemented. Conclusions Success factors included experienced improvement leaders, a focus on engaging front-line staff, the situational use of lean principles to make the work easier, better, faster and cheaper (in that order of emphasis), and the use of statistical process control to learn from variation. The challenge of transforming care delivery in the safety net warrants a closer look at the principles, relevance and potential impact of lean thinking in FQHCs.
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Affiliation(s)
- Patrick Lee
- Medicine, North Shore Medical Center, Salem, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Lynn Community Health Center, Lynn, Massachusetts, USA
| | - Linhchi Pham
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | | | - Kimberly Eng
- Lynn Community Health Center, Lynn, Massachusetts, USA
| | - Elena Freydin
- Lynn Community Health Center, Lynn, Massachusetts, USA.,School of Nursing, Salem State University, Salem, Massachusetts, USA
| | - Tayla Rose
- Lynn Community Health Center, Lynn, Massachusetts, USA.,Department of Pharmacy and Health Systems Sciences, Northeastern University School of Pharmacy, Boston, Massachusetts, USA
| | - Alyssa Ruiz
- Lynn Community Health Center, Lynn, Massachusetts, USA
| | - Joyce Reen
- Lynn Community Health Center, Lynn, Massachusetts, USA
| | | | - Vanna Altman
- Lynn Community Health Center, Lynn, Massachusetts, USA
| | | | - Alice Lee
- Lean Enterprise Institute, Cambridge, Massachusetts, USA
| | - Kiame Mahaniah
- Lynn Community Health Center, Lynn, Massachusetts, USA.,Tufts University School of Medicine, Boston, Massachusetts, USA
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West LM, Brincat A, Mercieca M, Fsadni D, Rapa I, Cordina M. Applying lean methodology to improve parenteral chemotherapy and monoclonal antibody documentation processes based on Normalisation Process Theory. Eur J Hosp Pharm 2018; 25:32-37. [PMID: 31156982 DOI: 10.1136/ejhpharm-2016-001046] [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: 07/09/2016] [Revised: 11/25/2016] [Accepted: 12/01/2016] [Indexed: 11/04/2022] Open
Abstract
Objective To determine the impact of lean thinking on the original time required to prepare the necessary documentation in relation to the preparation of parenteral chemotherapy/monoclonal antibodies. Method Four pharmacists and one pharmacy technician from the oncology hospital (Malta) all participated in eight focus groups linked to the different constructs of Normalisation Process Theory (NPT): coherence, cognitive participation, collective action and reflexive monitoring. The value stream documentation process was mapped by analysing all steps in the process where each activity must add value for the patient; tools of lean thinking were applied. Points causing delay in processing were considered critical; possible changes to minimise time waste were discussed and implemented. Time spent on critical points was measured by timing in minutes each step of the process 1 month before and after the changes had been implemented and calculating the mean±SD. An audit was performed comparing the process with standard operating procedures to determine whether any steps required quality improvement. Results Three critical points were identified: time required to search for pharmacy patient medication records for chemotherapy/monoclonal antibodies required on the day; time to generate preparation labels; and time to generate worksheets. Overall, a total of 122±8.6 min (p=0.06) were saved per day, a 37% decrease from the original documentation time. Five deficiencies were identified in the documentation process audit; corrective action was proposed. Conclusions By applying lean thinking, non-value-added steps leading to time waste in the documentation process were eliminated. This concept could be implemented by using NPT as part of a strategic system to reduce waste.
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Affiliation(s)
- Lorna Marie West
- Department of Clinical Pharmacology and Therapeutics, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Alison Brincat
- Sir Anthony Mamo Oncology Centre, Mater Dei Hospital Msida, Msida, Malta
| | - Mark Mercieca
- Sir Anthony Mamo Oncology Centre, Mater Dei Hospital Msida, Msida, Malta
| | - Demis Fsadni
- Sir Anthony Mamo Oncology Centre, Mater Dei Hospital Msida, Msida, Malta
| | - Ian Rapa
- Sir Anthony Mamo Oncology Centre, Mater Dei Hospital Msida, Msida, Malta
| | - Maria Cordina
- Department of Clinical Pharmacology and Therapeutics, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
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Nowak M, Pfaff H, Karbach U. Does Value Stream Mapping affect the structure, process, and outcome quality in care facilities? A systematic review. Syst Rev 2017; 6:170. [PMID: 28838320 PMCID: PMC5571664 DOI: 10.1186/s13643-017-0563-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 08/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Quality improvement within health and social care facilities is needed and has to be evidence-based and patient-centered. Value Stream Mapping, a method of Lean management, aims to increase the patients' value and quality of care by a visualization and quantification of the care process. The aim of this research is to examine the effectiveness of Value Stream Mapping on structure, process, and outcome quality in care facilities. METHODS A systematic review is conducted. PubMed, EBSCOhost, including Business Source Complete, Academic Search Complete, PSYCInfo, PSYNDX, SocINDEX with Full Text, Web of Knowledge, and EMBASE ScienceDirect are searched in February 2016. All peer-reviewed papers evaluating Value Stream Mapping and published in English or German from January 2000 are included. For data synthesis, all study results are categorized into Donabedian's model of structure, process, and outcome quality. To assess and interpret the effectiveness of Value Stream Mapping, the frequencies of the results statistically examined are considered. RESULTS Of the 903 articles retrieved, 22 studies fulfill the inclusion criteria. Of these, 11 studies are used to answer the research question. Value Stream Mapping has positive effects on the time dimension of process and outcome quality. It seems to reduce non-value-added time (e.g., waiting time) and length of stay. All study designs are before and after studies without control, and methodologically sophisticated studies are missing. CONCLUSIONS For a final conclusion about Value Stream Mapping's effectiveness, more research with improved methodology is needed. Despite this lack of evidence, Value Stream Mapping has the potential to improve quality of care on the time dimension. The contextual influence has to be investigated to make conclusions about the relationship between different quality domains when applying Value Stream Mapping. However, for using this review's conclusion, the limitation of including heterogeneous and potentially biased results has to be considered.
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Affiliation(s)
- Marina Nowak
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), Faculty of Human Sciences, Faculty of Medicine, University of Cologne, Eupener Strasse 129, 50933 Cologne, Germany
| | - Holger Pfaff
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), Faculty of Human Sciences, Faculty of Medicine, University of Cologne, Eupener Strasse 129, 50933 Cologne, Germany
| | - Ute Karbach
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), Faculty of Human Sciences, Faculty of Medicine, University of Cologne, Eupener Strasse 129, 50933 Cologne, Germany
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11
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O'Donnell M, Alvarez-Iglesias A, McGuire BE, Dinneen SF. The impact of sharing personalised clinical information with people with type 2 diabetes prior to their consultation: A pilot randomised controlled trial. PATIENT EDUCATION AND COUNSELING 2016; 99:591-599. [PMID: 26654869 DOI: 10.1016/j.pec.2015.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 11/12/2015] [Accepted: 11/14/2015] [Indexed: 06/05/2023]
Abstract
AIM To assess the impact of sharing personalised clinical information with people with type 2 diabetes prior to their out-patient consultation on patient involvement during the consultation, diabetes self-management self-efficacy and glycaemic control. METHODS A pilot three-arm randomised controlled trial. The 'intervention booklet' group received a booklet including personalised clinical information, a 'general information booklet' control group received a booklet with no personalised clinical information and a 'usual care' control group received no written information. RESULTS 136 people took part. The intervention group were significantly more likely to have shown the booklet to a 'significant other', (48% V 23%, p<0.05), brought the booklet with them to the clinic (85% V 35%, p<0.005) and to refer to the booklet during the consultation (45% V 13%, p<0.005). No significant differences in patient involvement during the consultation, diabetes management self-efficacy or glycaemic control were found between the three groups. CONCLUSIONS Although participants found it useful to receive their clinical results, no differences were found in the patient outcomes measured. PRACTICE IMPLICATIONS Further pilot work on the timing of the intervention, who it is targeted at and what outcomes are measured is warranted before proceeding to a full-scale RCT.
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Affiliation(s)
- M O'Donnell
- Discipline of Medicine, NUI Galway, Ireland.
| | | | | | - S F Dinneen
- Discipline of Medicine, NUI Galway, Ireland; Department of Diabetes and Endocrinology, Galway University Hospitals, Ireland
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Lawal AK, Rotter T, Kinsman L, Sari N, Harrison L, Jeffery C, Kutz M, Khan MF, Flynn R. Lean management in health care: definition, concepts, methodology and effects reported (systematic review protocol). Syst Rev 2014; 3:103. [PMID: 25238974 PMCID: PMC4171573 DOI: 10.1186/2046-4053-3-103] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 09/08/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lean is a set of operating philosophies and methods that help create a maximum value for patients by reducing waste and waits. It emphasizes the consideration of the customer's needs, employee involvement and continuous improvement. Research on the application and implementation of lean principles in health care has been limited. METHODS This is a protocol for a systematic review, following the Cochrane Effective Practice and Organisation of Care (EPOC) methodology. The review aims to document, catalogue and synthesize the existing literature on the effects of lean implementation in health care settings especially the potential effects on professional practice and health care outcomes. We have developed a Medline keyword search strategy, and this focused strategy will be translated into other databases. All search strategies will be provided in the review. The method proposed by the Cochrane EPOC group regarding randomized study designs, non-randomised controlled trials controlled before and after studies and interrupted time series will be followed. In addition, we will also include cohort, case-control studies, and relevant non-comparative publications such as case reports. We will categorize and analyse the review findings according to the study design employed, the study quality (low- versus high-quality studies) and the reported types of implementation in the primary studies. We will present the results of studies in a tabular form. DISCUSSION Overall, the systematic review aims to identify, assess and synthesize the evidence to underpin the implementation of lean activities in health care settings as defined in this protocol. As a result, the review will provide an evidence base for the effectiveness of lean and implementation methodologies reported in health care. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42014008853.
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Affiliation(s)
- Adegboyega K Lawal
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon S7N 5A2, Canada.
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