Effects of Lean Interventions Supported by Digital Technologies on Healthcare Services: A Systematic Review

Leveraging Kaizen with Process Mining in Healthcare Settings: A Conceptual Framework for Data-Driven Continuous Improvement

Background/Objectives: Healthcare systems face persistent challenges in improving efficiency, optimizing resources, and delivering high-quality care. Traditional continuous improvement methodologies often rely on subjective assessments, while data-driven approaches typically lack human-centered adaptability. This study aims to develop an integrated framework combining Kaizen principles with Process Mining capabilities to address these limitations in healthcare process optimization. Methods: This research employed a structured literature review approach to identify key concepts, methodologies, and applications of both Kaizen and Process Mining in healthcare settings. The study synthesized insights from the peer-reviewed literature published in the last two decades to develop a conceptual framework integrating these approaches for healthcare process improvement. Results: The proposed framework combines Kaizen's employee-driven approach to eliminating inefficiencies with Process Mining's ability to analyze workflow data and identify process deviations. The integration is structured into four key phases: data collection, process analysis, Kaizen events, and continuous monitoring. This structure creates a feedback loop where data-driven insights inform collaborative problem-solving, resulting in sustained improvements validated through objective process analysis. Conclusions: The integration of Kaizen and Process Mining offers a promising approach to enhancing workflow efficiency, reducing operational errors, and improving resource utilization in healthcare settings. While challenges such as data quality concerns, resource constraints, and potential resistance to change must be addressed, the framework provides a foundation for more effective process optimization. Future research should focus on empirical validation, AI-enhanced analytics, and assessing adaptability across diverse healthcare contexts.

Factors influencing adherence to home based pulmonary rehabilitation programme by high risk patients awaiting lung surgery: mixed methods study

OBJECTIVE

Preoperative home based pulmonary rehabilitation (HPR) can reduce postoperative complications in lung surgery patients. This study aimed to investigate the level of adherence to a preoperative HPR programme in high risk patients awaiting lung surgery, and factors influencing adherence.

DESIGN

A mixed methods explanatory sequential design consisting of a quantitative questionnaire survey and a qualitative interview study.

SETTING

The study was conducted at a tertiary hospital in Chongqing, China.

PARTICIPANTS

186 high risk patients awaiting lung surgery were enrolled in the preoperative HPR programme. All 186 patients participated in the quantitative questionnaire survey. 13 of the 186 patients were selected to participate in the qualitative interview study.

RESULTS

Quantitative questionnaire results revealed an adherence rate of 52.3%. Marital status, residence location, exercise habit, smoking index and pulmonary function were identified as independent influencers of adherence (p<0.05). Qualitative interviews identified poor health, lack of family and social support, adverse weather condition, arduous preoperative examination and unfit exercise intensity as barriers to adherence, and perceived health benefits, family support, and flexibility and convenience in exercise time and space as factors encouraging adherence.

CONCLUSIONS

High risk patients awaiting lung surgery adhered to preoperative HPR at a moderate level. A tiered approach can be used to develop personalised HPR protocols based on patients' individual needs and situations to improve adherence and maximise the benefits of HPR.

The Feasibility of AgileNudge+ Software to Facilitate Positive Behavioral Change: Mixed Methods Design

BACKGROUND

In today's digital age, web-based apps have become integral to daily life, driving transformative shifts in human behavior. "AgileNudge+" (Indiana University Center for Health Innovation and Implementation Science) is a web-based solution to simplify the process of positive behavior change using nudging as an intervention. By integrating knowledge from behavioral economics with technology, AgileNudge+ organizes multiple steps, simplifies complex tasks, minimizes errors by enhancing user engagement, and provides resources for creating and testing nudge interventions.

OBJECTIVE

This paper aimed to outline the design process, methodologies, and usefulness of "AgileNudge+" for the development of evidence-based nudges. It used a mixed methods approach to evaluate the software's interface usability and usefulness for creating and testing nudge interventions.

METHODS

AgileNudge+ was developed through iterative processes integrating principles from behavioral economics and user-centered design. The content of AgileNudge+ operationalizes an Agile science-based process to efficiently design, embed, and disseminate evidence-based nudges that encourage positive behavior change without limiting choice. Using a mixed methods approach, we tested AgileNudge+ software's ability to organize and simplify the nudge intervention process, allowing a diverse range of scholars with limited knowledge of Agile science to use nudges. Usability testing assessed the tool's usefulness and interface with a sample of 18 health care professionals, each asked to interact with the software and create a nudge intervention to solve a problem within their professional project's sphere.

RESULTS

The study was funded in August 2022, with data collection occurring from June 2023 to July 2024. As of July 2024, we have enrolled 18 participants. Quantitative results found a mean usefulness rating of AgileNudge+ of 3.83 (95% CI 3.00-4.66). Qualitative results highlighted ways to modify the language used in AgileNudge+ to be more comprehensible to a diverse user base and promoted modifications to the software that facilitate real-time assistance and prioritize time efficiency in user interactions. Feedback further supported the positive impact of gamification on participant motivation when using the software.

CONCLUSIONS

AgileNudge+ is an effective assistive tool for simplifying the positive behavior change process using nudge interventions, with tailored content and interactions to meet users' needs and demands. Building onto the current design, future iterations of AgileNudge+ will use artificial intelligence to process large volumes of data while reducing the time and mental energy required to scan for existing cognitive biases and nudge prototypes. The software is also being upgraded to build on current gamification efforts, encouraging more sustained motivation by increasing the temporal resolution of the digital interface. These modifications stay true to the agility and user-centered aspects of AgileNudge+, emphasizing the novelty of the constantly evolving software design process.

A framework for lean implementation in preoperative assessment: Evidence from a high complexity hospital in Italy

Purpose: A routine preoperative assessment is considered both ineffective and inefficient. Despite the widespread application of lean thinking in healthcare, there is little evidence of successful experiences in preoperative admissions in order to reduce "No value added" activities. A conceptual framework reporting the drivers (clinic, tools, innovation, organization, and governance) and impacts (patient, efficiency, sustainability, time, learning and growth) was developed. Methodology: Drawing on the experience of an Italian high complexity hospital, this paper analyzes the case study by reporting evidence on how to implement lean in preoperative assessment and how to evaluate the positive results obtained. Results: Applying lean principles, the identification of value improved the appropriateness of care by creating 40 personalized pathways; the value stream resulted in a reduction of "No Value Added Time" from 37% to 28%, chest X-rays from 41% to 14% and cardiac visits from 49% to 37%; the pursuit of continuous flow through innovation contributed to increase the use of digitalization; the new pull organization helped to reduce the average time spent per year by 1.5 h; the continuous improvement was ensured through the governance of results. Conclusion: The proposed framework should be used to improve the quality of care in preoperative admissions by adopting the lean drivers for successful implementation and reporting the impacts.

Antecedents of innovative work behavior among leading physicians: Empirical evidence from German hospitals

Healthcare professionals' innovative work behavior (IWB) plays a key role in the development and implementation of innovative solutions in hospitals. However, relevant antecedents of IWB have not been fully captured to date. This study empirically examines the relationships between proactive personality, collaborative competence, innovation climate, and IWB. Hypotheses were tested using a sample of 442 chief physicians from 380 German hospitals. The results indicate a positive and significant influence of proactive personality, collaborative competence, and innovation climate on IWB, with collaborative competence having a stronger influence on IWB than innovation climate. Managers should note that important resources for IWB are accessible through a variety of actors and relationships. To leverage these resources and thus promote IWB, more emphasis should be placed on an employee's network.

Effects of a Modified Six-Sigma-Methodology-Based Training Program on Core Competencies in Rehabilitation Nurse Specialists

PURPOSE

Nurses play an important role in ensuring patient rehabilitation and are involved in all aspects of multidimensional rehabilitation. Therefore, strengthening rehabilitation nursing education is vital to ascertain high-quality rehabilitation and optimum outcomes. This study examined the effectiveness of a new teaching reform-a modified Six-Sigma-based training program-against a conventional educational program on rehabilitation specialist nurses' core competencies, post-training performance, and satisfaction.

METHODS

A quasi-randomized controlled trial was conducted to assess the effectiveness of the modified training program. We recruited 56 learners from the 2020 training course at the Hunan Rehabilitation Specialist Nurse Training Base as the control group. Sixty learners from the base's 2021 training course were recruited as the intervention group. Data were collected in a consistent manner from both groups after the training program was implemented.

RESULTS

Those who underwent the modified training program showed better improvement in all core competencies than those who underwent the conventional training program (p < .05); the scores for theoretical knowledge, clinical nursing lectures, reviews, and nursing case management improved significantly following the teaching reform (p < 0.05). Further, overall satisfaction as well as base management and theoretical teaching satisfaction improved significantly (p < .05).

CONCLUSION

The modified training program strengthens rehabilitation nurses' base management abilities; enhances their core competencies; expands their interest in and breadth, depth, and practicability of theoretical courses; and updates the teaching methods.

Lean Perspectives in an Organizational Change in a Scientific Direction of an Italian Research Institute: Experience of the Cancer Institute of Bari

Lean management is a relatively new organizational vision transferred from the automotive industry to the healthcare and administrative sector based on analyzing a production process to emphasize value and reduce waste. This approach is particularly interesting in a historical moment of cuts and scarcity of economic resources and could represent a low-cost organizational solution in many production companies. In this work, we analyzed the presentation and the initial management of current ministerial research projects up to the approval by the Scientific Directorate of an Italian research institute. Furthermore, the initial mode in 2021 ("as is") and the potential mode ("to be") according to a Lean model are studied, according to the current barriers highlighted by the final users of the process and carrying out some perspective analyses with some reference indicators.

Virtual Reality in Health Science Education: Professors’ Perceptions

Virtual reality (VR) is a simulated experience in a three-dimensional (3D) computer-simulated world. Recent advances in technology position VR as a multipurpose technology in the healthcare sector and as a critical component in achieving Health 4.0. In this article, descriptive and correlationally quantitative research is carried out on the assessments made by Latin American health sciences university professors on the didactic use of virtual reality technologies. The main objective was to analyze the differences in the perceptions expressed by the public or private tenure of the universities where the professors teach. In addition, gender and age gaps were identified in the assessments obtained from each of the types of universities. The results reveal that Latin American health science professors at private universities have a higher selfconcept of their digital skills for the use of virtual reality in the lectures. This greater selfconcept also leads to a reduction in the gender and age gaps in the participating private universities with respect to the public counterparts. It is advisable to increase both faculty training in the didactic use of virtual reality and funding for its use, mainly in public universities.

Stress Distribution Analysis of Threaded Implants for Digital Dentistry

In this study, stability evaluation is performed through structural analysis based on digital dental implant design variables. The design variables include the implant length and thickness, cortical bone thickness, and elastic modulus of the cancellous bone. Subsequently, the stress in the external cortical bone, in which numerous nerves exist, is analyzed. Results show that stress increases as the implant length decreases. However, when the implant length is 10 mm, the stress decreases, owing to stress dispersion at the lower section of the implant. Moreover, as the implant thickness increases, the stress decreases. As the elastic modulus of the cancellous bone decreases, the stress exerted on the cancellous bone decreases; consequently, the stress exerted on the cortical bone increases. Finally, as the thickness of the cortical bone increases, the stress decreases when a vertical load is applied. However, when a load is applied in the oblique direction, the stress increases. Based on data obtained via digital radiography, which is a digital dental technology, a more precise implantation plan will be established by substituting the data via structural analysis.