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Suman G, Prajapati DR. Utilization of Lean & Six Sigma quality initiatives in Indian healthcare sector. PLoS One 2021; 16:e0261747. [PMID: 34941958 PMCID: PMC8699985 DOI: 10.1371/journal.pone.0261747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 12/09/2021] [Indexed: 11/19/2022] Open
Abstract
PURPOSE The purpose of this paper is to investigate the utilization of Lean & Six Sigma quality initiatives in healthcare sector in India. METHODOLOGY The survey questionnaires were sent to 454 hospitals through registered postal in all the states of India. The survey questionnaire was designed to assess different quality initiatives; currently implemented in Indian hospitals, factors align with organization's objectives, reasons for not implementing Lean & Six Sigma and contribution of Lean & Six Sigma projects in healthcare improvement projects etc. A separate section in the questionnaire provides the feedback on implementation of Lean & Six Sigma in various hospitals. The relationships between Lean & Six Sigma and healthcare performance have also been established in this paper. FINDINGS It is found that 15 Nos. of hospitals have implemented the Lean tools while 14 Nos. have implemented the Six Sigma tools out of 109 collected responses. This shows the utilization of Lean & Six Sigma in Indian healthcare sector. The 'Lack of knowledge' and 'Availability of resources' are the major reasons for not implementing Lean & Six Sigma. It is also observed that 22% running projects were related to Lean & Six Sigma out of various improvement projects running in various hospitals. ORIGINALITY There is lack of evidences of similar studies that determines the utilization of Lean & Six Sigma in Indian healthcare sector at the national level. This paper will provide important breakthrough to academicians and healthcare practitioners, who are involved in Lean & Six Sigma research. SOCIAL IMPLICATIONS The present study will create awareness among healthcare practitioners across India for utilization of quality tools that will provide direct benefits to the society.
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Affiliation(s)
- Gaurav Suman
- Department of Mechanical Engineering, Punjab Engineering College (Deemed to be University), Chandigarh, India
| | - Deo Raj Prajapati
- Department of Mechanical Engineering, Punjab Engineering College (Deemed to be University), Chandigarh, India
- * E-mail:
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Al-Hakim L, Sevdalis N. A Novel Conceptual Approach to Lean: Value, Psychological Conditions for Engagement With Work and Perceived Organisational Support in Hospital Care. Int J Qual Health Care 2021; 33:6404025. [PMID: 34668018 PMCID: PMC8897978 DOI: 10.1093/intqhc/mzab148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 07/20/2021] [Accepted: 10/19/2021] [Indexed: 11/24/2022] Open
Abstract
Background Lean thinking (LT) has emerged as a promising approach for reducing waste and improving efficiency. However, its applicability to and effectiveness within healthcare, particularly within hospital-based care, remains clouded by uncertainty. This paper attempts to answer the question ‘how lean thinking can best be applied to hospital-based care’. Methods Narrative review and conceptual synthesis Results We first review the principles of LT and how some of them are challenging to apply within hospital-based care. We then highlight that lean is an approach that was always meant as a combination of technical expertise and a focus on people—supported by a suite of human resource management supportive practices. We proceed to introduce evidence stemming from the literature studies on perceived organizational support and the psychological conditions for successful staff engagement with their work (namely, psychological meaningfulness, availability and safety as experienced by staff) and review how they may apply to hospital-based health workers. We finally advance a set of hypotheses regarding how different facets of value in a hospital care pathway may be correlated and these relationships mediated/moderated by perceived organizational support and the psychological conditions for engagement with work. Conclusion We conclude with a discussion of the limitations of our work and the aspiration that the conceptual analysis we have offered is a useful and actionable framework for hospital management to explore how best to support their staff—in a manner that ultimately achieves better quality and patient experience of care.
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Affiliation(s)
- Latif Al-Hakim
- School of Business, University of Southern Queensland, West Street, Toowoomba, Queensland, QLD 4350
| | - Nick Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, King's College London, UK
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Volochtchuk AVL, Leite H. Process improvement approaches in emergency departments: a review of the current knowledge. INTERNATIONAL JOURNAL OF QUALITY & RELIABILITY MANAGEMENT 2021. [DOI: 10.1108/ijqrm-09-2020-0330] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe healthcare system has been under pressure to provide timely and quality healthcare. The influx of patients in the emergency departments (EDs) is testing the capacity of the system to its limit. In order to increase EDs' capacity and performance, healthcare managers and practitioners are adopting process improvement (PI) approaches in their operations. Thus, this study aims to identify the main PI approaches implemented in EDs, as well as the benefits and barriers to implement these approaches.Design/methodology/approachThe study is based on a rigorous systematic literature review of 115 papers. Furthermore, under the lens of thematic analysis, the authors present the descriptive and prescriptive findings.FindingsThe descriptive analysis found copious information related to PI approaches implemented in EDs, such as main PIs used in EDs, type of methodological procedures applied, as well as a set of barriers and benefits. Aiming to provide an in-depth analysis and prescriptive results, the authors carried out a thematic analysis that found underlying barriers (e.g. organisational, technical and behavioural) and benefits (e.g. for patients, the organisation and processes) of PI implementation in EDs.Originality/valueThe authors contribute to knowledge by providing a comprehensive review of the main PI methodologies applied in EDs, underscoring the most prominent ones. This study goes beyond descriptive studies that identify lists of barriers and benefits, and instead the authors categorize prescriptive elements that influence these barriers and benefits. Finally, this study raises discussions about the behavioural influence of patients and medical staff on the implementation of PI approaches.
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Ortíz-Barrios MA, Alfaro-Saíz JJ. Methodological Approaches to Support Process Improvement in Emergency Departments: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082664. [PMID: 32294985 PMCID: PMC7216091 DOI: 10.3390/ijerph17082664] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/22/2020] [Accepted: 04/03/2020] [Indexed: 02/07/2023]
Abstract
The most commonly used techniques for addressing each Emergency Department (ED) problem (overcrowding, prolonged waiting time, extended length of stay, excessive patient flow time, and high left-without-being-seen (LWBS) rates) were specified to provide healthcare managers and researchers with a useful framework for effectively solving these operational deficiencies. Finally, we identified the existing research tendencies and highlighted opportunities for future work. We implemented the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology to undertake a review including scholarly articles published between April 1993 and October 2019. The selected papers were categorized considering the leading ED problems and publication year. Two hundred and three (203) papers distributed in 120 journals were found to meet the inclusion criteria. Furthermore, computer simulation and lean manufacturing were concluded to be the most prominent approaches for addressing the leading operational problems in EDs. In future interventions, ED administrators and researchers are widely advised to combine Operations Research (OR) methods, quality-based techniques, and data-driven approaches for upgrading the performance of EDs. On a different tack, more interventions are required for tackling overcrowding and high left-without-being-seen rates.
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Affiliation(s)
- Miguel Angel Ortíz-Barrios
- Department of Industrial Management, Agroindustry and Operations, Universidad de la Costa CUC, Barranquilla 081001, Colombia
- Correspondence: ; Tel.: +57-3007239699
| | - Juan-José Alfaro-Saíz
- Research Centre on Production Management and Engineering, Universitat Politècnica de València, 46022 Valencia, Spain;
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Verbano C, Crema M. Applying lean management to reduce radiology turnaround times for emergency department. Int J Health Plann Manage 2019; 34:e1711-e1722. [PMID: 31397026 DOI: 10.1002/hpm.2884] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 06/18/2019] [Accepted: 07/30/2019] [Indexed: 11/10/2022] Open
Abstract
Given the high impact of emergency department (ED) on the quality of care delivered by an hospital, and the many challenges it is facing (eg, overcrowding, excessive waiting time, cost containment, and increasing demand from patients), innovative managerial approaches should be adopted in order to develop safer and more efficient healthcare in this setting. The current study focuses on an application of lean thinking to reduce radiology turnaround times for ED, with the final aim to highlight the key factors enabling the adoption of lean thinking in this context. A research framework has been developed in the literature to analyse lean projects in healthcare and it has been adapted to study the case selected in an Italian hospital. In particular, organizational aspects, phases, and activities of the applied methodology, tools and procedures, and the achieved outcomes have been analysed. The study reports how radiology turnaround times for ED can be significantly reduced applying lean management principles and techniques. The achieved results contribute not only to comply with the regulation, but also to enhance the quality of care delivered to the patient; moreover, staff communication, involvement, and process awareness are favoured by the realization of similar projects promoting the diffusion of a lean culture.
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Affiliation(s)
- Chiara Verbano
- Department of Management and Engineering, University of Padova, Vicenza, Italy
| | - Maria Crema
- Department of Management and Engineering, University of Padova, Vicenza, Italy
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Sánchez M, Suárez M, Asenjo M, Bragulat E. Improvement of emergency department patient flow using lean thinking. Int J Qual Health Care 2018; 30:250-256. [PMID: 29447352 DOI: 10.1093/intqhc/mzy017] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 01/25/2018] [Indexed: 11/12/2022] Open
Abstract
Objective To apply lean thinking in triage acuity level-3 patients in order to improve emergency department (ED) throughtput and waiting time. Design A prospective interventional study. Setting An ED of a tertiary care hospital. Participants Triage acuity level-3 patients. Intervention(s) To apply lean techniques such as value stream mapping, workplace organization, reduction of wastes and standardization by the frontline staff. Main Outcome Measure(s) Two periods were compared: (i) pre-lean: April-September, 2015; and (ii) post-lean: April-September, 2016. Variables included: median process time (time from beginning of nurse preparation to the end of nurse finalization after doctor disposition) of both discharged and transferred to observation patients; median length of stay; median waiting time; left without being seen, 72-h revisit and mortality rates, and daily number of visits. There was no additional staff or bed after lean implementation. Results Despite an increment in the daily number of visits (+8.3%, P < 0.001), significant reductions in process time of discharged (182 vs 160 min, P < 0.001) and transferred to observation (186 vs 176 min, P < 0.001) patients, in length of stay (389 vs 329 min, P < 0.001), and in waiting time (71 vs 48 min, P < 0.001) were achieved after lean implementation. No significant differences were registered in left without being seen rate (5.23% vs 4.95%), 72-h revisit rate (3.41% vs 3.93%), and mortality rate (0.23% vs 0.15%). Conclusion Lean thinking is a methodology that can improve triage acuity level-3 patient flow in the ED, resulting in better throughput along with reduced waiting time.
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Affiliation(s)
- Miquel Sánchez
- Emergency Department, Hospital Clínic de Barcelona, Grup d'Investigació 'Urgencias: procesos y patologias', IDIBAPS, Villarroel 160, 08036 Barcelona, Catalonia, Spain
| | - Montse Suárez
- Emergency Department, Hospital Clínic de Barcelona, Villarroel 160, 08036 Barcelona, Catalonia, Spain
| | - María Asenjo
- Emergency Department, Hospital Clínic de Barcelona, Villarroel 160, 08036 Barcelona, Catalonia, Spain
| | - Ernest Bragulat
- Emergency Department, Hospital Clínic de Barcelona, Grup d'Investigació 'Urgencias: procesos y patologias', IDIBAPS, Villarroel 160, 08036 Barcelona, Catalonia, Spain
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Nicosia FM, Park LG, Gray CP, Yakir MJ, Hung DY. Nurses' Perspectives on Lean Redesigns to Patient Flow and Inpatient Discharge Process Efficiency. Glob Qual Nurs Res 2018; 5:2333393618810658. [PMID: 30480041 PMCID: PMC6249655 DOI: 10.1177/2333393618810658] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 10/09/2018] [Accepted: 10/11/2018] [Indexed: 10/27/2022] Open
Abstract
As hospitals around the world increasingly face pressure to improve efficiency, "Lean" process improvement has become a popular approach to improving patient flow. In this article, we examine nurses' perspectives on the implementation of Lean redesigns to the inpatient discharge process. We found that nurses experienced competing demands and tensions related to their time and professional roles and responsibilities as a result of Lean. Four main themes included (a) addressing the needs of individual patients, while still maintaining overall patient flow; (b) meeting discharge efficiency targets while also achieving high patient satisfaction scores; (c) "wasting time" to save time; and (d) the "real" work of providing clinical care versus the "Lean" work of process improvement. Our findings highlight the importance of soliciting hospital nurses' perspectives when implementing Lean process improvements to improve efficiency and patient flow.
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Affiliation(s)
- Francesca M. Nicosia
- University of California, San Francisco, California, USA
- San Francisco Veterans Medical Center, San Francisco, California, USA
| | - Linda G. Park
- University of California, San Francisco, California, USA
- San Francisco Veterans Medical Center, San Francisco, California, USA
| | | | - Maayan J. Yakir
- Palo Alto Medical Foundation, Research Institute of Sutter Health, Mountain View, California, USA
| | - Dorothy Y. Hung
- Palo Alto Medical Foundation, Research Institute of Sutter Health, Mountain View, California, USA
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Holden RJ. Lean Thinking in emergency departments: a critical review. Ann Emerg Med 2010; 57:265-78. [PMID: 21035904 DOI: 10.1016/j.annemergmed.2010.08.001] [Citation(s) in RCA: 221] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Revised: 06/09/2010] [Accepted: 08/02/2010] [Indexed: 11/29/2022]
Abstract
Emergency departments (EDs) face problems with crowding, delays, cost containment, and patient safety. To address these and other problems, EDs increasingly implement an approach called Lean thinking. This study critically reviewed 18 articles describing the implementation of Lean in 15 EDs in the United States, Australia, and Canada. An analytic framework based on human factors engineering and occupational research generated 6 core questions about the effects of Lean on ED work structures and processes, patient care, and employees, as well as the factors on which Lean's success is contingent. The review revealed numerous ED process changes, often involving separate patient streams, accompanied by structural changes such as new technologies, communication systems, staffing changes, and the reorganization of physical space. Patient care usually improved after implementation of Lean, with many EDs reporting decreases in length of stay, waiting times, and proportion of patients leaving the ED without being seen. Few null or negative patient care effects were reported, and studies typically did not report patient quality or safety outcomes beyond patient satisfaction. The effects of Lean on employees were rarely discussed or measured systematically, but there were some indications of positive effects on employees and organizational culture. Success factors included employee involvement, management support, and preparedness for change. Despite some methodological, practical, and theoretic concerns, Lean appears to offer significant improvement opportunities. Many questions remain about Lean's effects on patient health and employees and how Lean can be best implemented in health care.
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Affiliation(s)
- Richard J Holden
- School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USA.
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Use of Lean in the Emergency Department: A Case Series of 4 Hospitals. Ann Emerg Med 2009; 54:504-10. [DOI: 10.1016/j.annemergmed.2009.03.024] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2008] [Revised: 03/12/2009] [Accepted: 03/23/2009] [Indexed: 11/18/2022]
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