Healthcare Engineering: A Lean Management Approach

Customers' Perception Towards Accountability of Diagnostic Centres: Evidence from India

Introduction

A deeper comprehension of accountability is beneficial for identifying and fostering tactics to boost accountability and raise the standard of healthcare. The main objective of the present paper is to measure the level of customers' perception of accountability of healthcare diagnostic service providers and to identify the factors that influence the perception of accountability of healthcare diagnostic service customers.

Methods

A questionnaire survey was used to collect data from 393 customers of various diagnostic centers in the city of Guwahati from the state of Assam in India. The reliability of the data was tested using Cronbach's Alpha. Statistical tests were used for the mean, percentage, standard deviation, etc. Factor analysis was performed to find out the factors affecting customers' perception of accountability.

Results

It was found that the overall level of perception of the customers with respect to the accountability of diagnostic centers in Guwahati is of high level. The study reveals four variables that affect how customers perceive the accountability of diagnostic service providers. These are Competency, Responsiveness, Compliance with protocol, and Problem-solving approach.

Discussion

Significant contributions have been made by the present study in terms of the development of a scale to measure customers' perception of accountability of diagnostic centre, and the development of a theoretical model to explain this accountability.

Quality improvement in urological care: Core methodological principles

Objectives:

The aim of this article is to summarise core quality improvement (QI) methodologies and concepts to assist urology teams in conducting well-designed improvement projects.

Materials and Methods:

We provide an introduction to the methodological foundations of QI, including the model for improvement, plan-do-study-act, lean and six sigma and present some useful QI tools such as process modelling and pareto charts with examples of how they might be applied to urological care. We also introduce the concept of measurement for QI and describe how this differs from the more traditional measurement approaches used in research.

Results:

The key to successful QI work undoubtedly lies in the careful planning and appropriate selection of the available QI tools and methods, alongside pragmatic approaches to measurement that yield enough data to spot meaningful variation in outcomes.

Conclusions:

To support these core methods, QI leadership and stakeholder engagement will be critical to embedding QI into urological care and ensuring that improvements can be sustained once QI projects come to an end.

Level of evidence:

Not applicable.

Lean ICU Layout Re-Design: A Simulation-Based Approach

Healthcare facilities require flexible layouts that can adapt quickly in the face of various disruptions. COVID-19 confirmed this need for both healthcare and manufacturing systems. Starting with the transfer of decision support systems from manufacturing, this paper generalizes layout re-design activities for complex systems by presenting a simulation framework. Through a real case study concerning the proliferation of nosocomial cross-infection in an intensive care unit (ICU), the model developed in systems dynamics, based on a zero order immediate logic, allows reproducing the evolution of the different agencies (e.g., physicians, nurses, ancillary workers, patients), as well as of the cyber-technical side of the ICU, in its general but also local aspects. The entire global workflow is theoretically founded on lean principles, with the goal of balancing the need for minimal patient throughput time and maximum efficiency by optimizing the resources used during the process. The proposed framework might be transferred to other wards with minimal adjustments; hence, it has the potential to represent the initial step for a modular depiction of an entire healthcare facility.

Prioritization of critical success factors for sustainable Lean Six Sigma implementation in Indian healthcare organizations using best-worst-method

Purpose

Recent years have seen an increased demand for healthcare services, presenting a need to improve service quality through the deployment of sustainable Lean Six Sigma (LSS). This study aims to identify critical success factors (CSFs) of sustainable LSS and prioritize them based on their intensity of importance for the effective implementation of sustainable LSS in the healthcare environment.

Design/methodology/approach

The present study identified 33 leading CSFs through a comprehensive literature review and expert experience and classified them into six major categories based on organizational functions. The primacy of these CSFs is established using the best-worst-method (BWM) approach. The significant advantage of this approach is that the decision-maker identifies both the best and worst criteria among alternatives prior to pairwise comparisons, leading to fewer pairwise comparisons and saving time, energy and resources. It also provides more reliable and consistent rankings.

Findings

The findings of the present study highlight the economic and managerial (E&M) CSFs as the most significant CSFs among the major category criteria of sustainable LSS-CSFs, followed by organizational (O), knowledge and learning (K&L), technological (T), social and environmental (S&E), and external factors (EF). Similarly, management involvement and leadership to implement sustainable LSS (E&M1), structured LSS deployment training and education (K&L2), and availability of required resources and their efficient utilization (O2) are ranked as the topmost CSFs among sub-category criteria of sustainable LSS-CSFs.

Practical implications

The prioritization of sustainable LSS-CSFs determined in this study can provide healthcare managers, researchers and decision-makers with a better understanding of the influence on effective deployment of sustainable LSS, resulting in improved service quality in hospitals.

Originality/value

This paper is an original contribution to the analysis of CSFs in an Indian healthcare institute, utilizing the BMW method for ranking the sustainable LSS-CSFs. The advantage of utilizing and distinguishing the performance of this approach compared to other MCDA approaches in terms of (1) least pairwise comparison and violation, (2) consistency (3) slightest deviation and (4) conformity.

Enhancing Healthcare Project Definition with Lean-Led Design

Decisions regarding project definition have a significant impact on client value generation. However, although this phase is of utmost importance, traditional management practices are inadequate, as the focus is rather on budget and technical aspects leaving aside the functional ones. Neglecting the functional aspects could have serious consequences on the operation and thus quality of workspace, especially in complex projects including hospitals that involve multiple clients and with a high degree of uncertainty of change. The Lean-led Design approach provides a participative solution which involves the main project clients, namely the users (doctors, patients, etc.), project managers, and the government, with the intention of delivering facilities with a better fit for purpose and use. The main objective of the paper is to develop a framework that summarizes the steps leading to the implementation of such an approach during the project definition of a new hospital. The methodology chosen is a case study and the main contribution is to develop theoretical knowledge regarding its implementation. This may support managers in their decisions when coordinating project definitions.

Improving performance of the hospitalization process by applying the principles of Lean Thinking

Purpose

The goal was to improve the quality of the hospitalization process and the management of patients, allowing the reduction of costs and the minimization of the preoperative Length of Hospital Stay (LOS).

Design/methodology/approach

The methodology used to improve the quality of the hospitalization process and patient management was Lean Thinking. Therefore, the Lean tools (Value stream map and Ishikawa diagram) were used to identify waste and inefficiencies, improving the process with the implementation of corrective actions. The data was collected through personal observations, patient interviews, brainstorming and from printed medical records of 151 patients undergoing oral cancer surgery in the period from 2006 to 2018.

Findings

The authors identified, through Value Stream Map, waste and inefficiencies during preoperative activities, consequently influencing preoperative LOS, considered the best performance indicator. The main causes were identified through the Ishikawa diagram, allowing reflection on possible solutions. The main corrective action was the introduction of the pre-hospitalization service. A comparative statistical analysis showed the significance of the solutions implemented. The average preoperative LOS decreased from 4.90 to 3.80 days (−22.40%) with a p-value of 0.001.

Originality/value

The methodology allowed to highlight the improvement of the patient hospitalization process with the introduction of the pre-hospitalization service. Therefore, by adopting the culture of continuous improvement, the flow of hospitalization was redrawn. The benefits of the solutions implemented are addressed to the patient in terms of lower LOS and greater service satisfaction and to the hospital for lower patient management costs and improved process quality. This article will be useful for those who need examples on how to apply Lean tools in healthcare.

A lean approach to healthcare management using multi criteria decision making

Recent challenges induced by the global pandemic COVID-19 have highlighted the critical importance of coping with a sudden surge in demand for front line healthcare services. Motivated by the success of lean implementation in manufacturing systems, this study attempts to apply the lean principles in healthcare delivery environments. The lean approach begins with the identification of seven types of wastes in any production or service system. This study attempts to identify and prioritize the present in hospitals. The study contributes to the existing body of knowledge in two ways. First, we identify the various sources contributing to the seven basic wastes in healthcare delivery. Second, we prioritize the seven types of wastes and the dimensions contributing to these wastes using a Multi-Criteria Decision Making (MCDM). This paper used the fuzzy analytical hierarchy process approach, which is a well-accepted tool in MCDM. The study was conducted at select hospitals located in and around Pune city in India. We find that waiting, transportation, motion, and defects are dominant in adopting lean practices among the seven wastes. The findings of this study may guide hospital management in strategic planning in adopting a lean healthcare process. To our knowledge, this is one of the first studies to extract, and prioritise lean wastes within the context of the healthcare sector.

Application of Lean 6s Methodology in an Engineering Education Environment during the SARS-CoV-2 Pandemic

In this work, the application of the Lean 6S methodology is exposed, which includes the Safety-Security activity in response to the demands caused by the epidemiological situation due to exposure to SARS-CoV-2, as well as its implementation through a standardized process in n higher education environment in the engineering field. The application of methodologies based on lean principles in the organizational system of an educational institution, causes an impact on the demands of organizational efficiency, where innovation and continuous improvement mark the path to success. The Lean 6S methodology, based on the development of six phases, guarantees, thanks to the impact of all its phases and especially of three of them: cleaning, standardize and safety, the control of the health risk against SARS-CoV-2. This guarantee is achieved through the permanent review of safety in the workplace. The areas of selected implementation to verify the effect have been the essential spaces for the development of the teaching activity: center accesses, learning rooms and practical laboratories. The laboratories are adapted to the security and organization conditions that are required in the regulations required by the Occupational Risk Prevention Services against exposure to SARS-CoV-2, since the appropriate protective equipment for the risk level is reviewed, the ordering of the workstations, the class attendance through the shifts organization and the rearrangement of the common places where the maintenance of a minimum interpersonal safety distance between the teaching staff, auxiliary services and students is guaranteed. The effort of the teaching staff in terms of following the established rules is notably increased. To balance this dedication, it is necessary to increase and rely on auxiliary personnel who guarantee rules compliance control in different spaces than the classroom and the laboratory.