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Fernandes HMDLG, Silva DD, Tarifa RR, Guirardello EDB. Construction and validation of an instrument for evaluating Lean Healthcare in healthcare institutions. Rev Gaucha Enferm 2024; 45:e20230061. [PMID: 38359279 DOI: 10.1590/1983-1447.2024.20230061.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/08/2023] [Indexed: 02/17/2024] Open
Abstract
OBJECTIVE To build and validate an instrument to evaluate Lean Healthcare in healthcare institutions. METHOD Methodological study conducted in three stages: 1) Instrument construction; 2) Content validity using the Delphi technique with 14 experts; and 3) Construct validation using Structural Equation Modeling with sample consisted of 113 professionals with experience in Lean Healthcare. Data collection carried out from October/2020 to January/2021 using a digital form. Data analysis performed with the SmartPLS2.0/M3 software. RESULTS Items were developed after an integrative review and divided into the dimensions Structure, Process and Outcome, according to Donabedian's theoretical framework. Content validation in two rounds of the Delphi technique. Final instrument, after model adjustment, containing 16 items with Cronbach's alpha of 0.77 in Structure, 0.71 in Process and 0.83 in Outcome. CONCLUSION The instrument presented evidence of validity and reliability, enabling its use in healthcare institutions to evaluate Lean Healthcare.
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Affiliation(s)
- Hellen Maria de Lima Graf Fernandes
- Universidade Estadual de Campinas (UNICAMP). Faculdade de Enfermagem. Campinas, São Paulo, Brasil
- Faculdade Anhanguera. Graduação em Enfermagem. Joinville, Santa Catarina, Brasil
- Associação Educacional Luterana Bom Jesus (IELUSC). Graduação em Enfermagem. Joinville, Santa Catarina, Brasil
| | - Dirceu da Silva
- Universidade Estadual de Campinas (UNICAMP). Faculdade de Educação. Campinas, São Paulo, Brasil
| | - Rosana Ribeiro Tarifa
- Universidade Estadual de Campinas (UNICAMP). Colégio Técnico de Campinas. Campinas, São Paulo, Brasil
- Faculdade Anhanguera de Sumaré (FSU). Graduação em Enfermagem. Sumaré, São Paulo, Brasil
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Scala A, Improta G. Lean Six Sigma Approach to Improve the Management of Patients Undergoing Laparoscopic Cholecystectomy. Healthcare (Basel) 2024; 12:292. [PMID: 38338177 PMCID: PMC10855321 DOI: 10.3390/healthcare12030292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/08/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
Laparoscopic cholecystectomy (LC) is the gold standard technique for gallbladder diseases in both emergency and elective surgery. The incidence of the disease related to an increasingly elderly population coupled with the efficacy and safety of LC treatment resulted in an increase in the frequency of interventions without an increase in surgical mortality. For these reasons, managers implement strategies by which to standardize the process of patients undergoing LC. Specifically, the goal is to ensure, in accordance with the guidelines of the Italian Ministry of Health, a reduction in post-operative length of stay (LOS). In this study, a Lean Six Sigma (LSS) methodological approach was implemented to identify and subsequently investigate, through statistical analysis, the effect that corrective actions have had on the post-operative hospitalization for LC interventions performed in a University Hospital. The analysis of the process, which involved a sample of 478 patients, with an approach guided by the Define, Measure, Analyze, Improve, and Control (DMAIC) cycle, made it possible to reduce the post-operative LOS from an average of 6.67 to 4.44 days. The most significant reduction was obtained for the 60-69 age group, for whom the probability of using LC is higher than for younger people. The LSS offers a methodological rigor that has allowed us, as already known, to make significant improvements to the process, standardizing the result by limiting the variability and obtaining a total reduction of post-operative LOS of 67%.
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Affiliation(s)
- Arianna Scala
- Department of Public Health, University of Naples “Federico II”, 80138 Naples, Italy;
| | - Giovanni Improta
- Department of Public Health, University of Naples “Federico II”, 80138 Naples, Italy;
- Interdepartmental Center for Research in Healthcare Management and Innovation in Healthcare (CIRMIS), University of Naples “Federico II”, 80138 Naples, Italy
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Vijverberg JRG, Rouppe van der Voort MBV, van der Nat PB, Mosselman MJ, Rigter S, Biesma DH, van Merode F. How to Use Lean Thinking for the Optimization of Clinical Pathways: A Systematic Review and a Proposed Framework to Analyze Pathways on a System Level. Healthcare (Basel) 2023; 11:2488. [PMID: 37761685 PMCID: PMC10530850 DOI: 10.3390/healthcare11182488] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/19/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
Lean Thinking and clinical pathways are commonly used concepts to improve healthcare. However, little is known on how to use Lean Thinking for the optimization of pathways or the quantification of both concepts. This study aims to create a framework to analyze pathways with Lean Thinking on a system level, by quantifying the seven wastes, flow and pull. A systematic literature review was performed. Inclusion criteria were the focus of the article on a well-defined group of patients and studied a pathway optimization with Lean Thinking. Data were extracted on measured outcomes, type of intervention and type of researched pathway. Thirty-six articles were included. No articles described the implementation of the Lean Thinking philosophy or studied the development of their people and partners ("4 P" model). Most articles used process optimization tools or problem-solving tools. The majority of the studies focused on process measures. The measures found in the review were used as input for our suggested framework to identify and quantify wastes, flow, and pull in a clinical pathway. The proposed framework can be used to create an overview of the improvement potential of a pathway or to analyze the level of improvement after an enhancement is introduced to a pathway. Further research is needed to study the use of the suggested quantifications.
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Affiliation(s)
- Joanna R. G. Vijverberg
- Care and Public Health Research Institute, Maastricht University, 6200 MD Maastricht, The Netherlands
- Maastricht University Medical Centre+, 6229 HX Maastricht, The Netherlands
- Department of Value Improvement, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands
| | | | - Paul B. van der Nat
- Department of Value Improvement, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, 6525 EP Nijmegen, The Netherlands
| | - Machteld J. Mosselman
- Department of Juiste Zorg, Juiste Plaats, Juiste Kosten, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands
| | - Sander Rigter
- Department of Anesthesiology and Intensive Care, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands
| | - Douwe H. Biesma
- Department of Internal Medicine, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Internal Medicine, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Frits van Merode
- Care and Public Health Research Institute, Maastricht University, 6200 MD Maastricht, The Netherlands
- Maastricht University Medical Centre+, 6229 HX Maastricht, The Netherlands
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Roey T, Hung DY, Rundall TG, Fournier PL, Zhong A, Shortell SM. Lean Performance Indicators and Facilitators of Outcomes in U.S. Public Hospitals. J Healthc Manag 2023; 68:325-341. [PMID: 37678825 DOI: 10.1097/jhm-d-22-00107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
GOAL This study investigated the association between Lean and performance outcomes in U.S. public hospitals. Public hospitals face substantial pressure to deliver high-quality care with limited resources. Lean-based management systems can provide these hospitals with alternative approaches to improve efficiency and effectiveness. Prior research shows that Lean can have positive impacts in hospitals ranging in ownership type, but more study is needed, specifically in publicly owned hospitals. METHODS We performed multivariable regressions using data from the 2017 National Survey of Lean/Transformational Performance Improvement. The data were linked to publicly available hospital performance data from the Agency for Healthcare Research and Quality and the Centers for Medicare & Medicaid Services. We examined 11 outcomes measuring financial performance, quality of care, and patient experience and their associations with Lean adoption. We also explored potential drivers of positive outcomes by examining Lean implementation in each hospital, measured as the number of units using Lean tools and practices; leader commitment to Lean principles; Lean training and education among physicians, nurses, and managers; and use of a daily management system among C-suite leaders and managers. PRINCIPAL FINDINGS Lean adoption and implementation were associated with improved performance in U.S. public hospitals. Compared with hospitals that did not adopt Lean, those that did had significantly lower adjusted inpatient expenses per discharge and higher-than-average national scores on the appropriate use of medical imaging and timeliness of care. The study results also showed marginally significant improvements in patient experience and hospital earnings before interest, taxes, depreciation, and amortization margins. Focusing on these select outcomes, we found that drivers of such improvements involved the extent of Lean implementation, as reflected by leadership commitment, daily management, and training/education while controlling for the number of years using Lean. PRACTICAL APPLICATIONS Lean is a method of continuous improvement centered around a culture of providing high-value care for patients. Our findings provide insight into the potential benefits of Lean in U.S. public hospitals. Notably, they suggest that leader buy-in is key to success. When executives and managers support Lean initiatives and provide proper training for the workforce, improved financial and operational performance can result. This commitment, starting with upper management, may also play a broader role in the effort to reform healthcare while having a positive impact on patient care in U.S. public hospitals.
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Affiliation(s)
| | | | | | | | | | - Stephen M Shortell
- Center for Lean Engagement & Research, Division of Health Policy and Management, University of California, Berkeley, California
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Koster F, Kok MR, van der Kooij J, Waverijn G, Weel-Koenders AEAM, Barreto DL. Dealing with Time Estimates in Hospital Cost Accounting: Integrating Fuzzy Logic into Time-Driven Activity-Based Costing. Pharmacoecon Open 2023:10.1007/s41669-023-00413-2. [PMID: 37129793 PMCID: PMC10152001 DOI: 10.1007/s41669-023-00413-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/26/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Time-driven activity-based costing (TDABC) can support value-based healthcare (VBHC) programs by providing insights into the actual relationships between time spent by the medical staff and the costs associated with specific care cycles. However, the robustness of time estimates (time variation) as well as the effort required to obtain these estimates are major challenges of the TDABC methodology, given the heterogeneity in patients' needs and the presence of (multi)morbidity. To allow for the variation in time estimates in an efficient manner, this study uses fuzzy logic (FL) to estimate the TDABC model parameters (FL-TDABC). METHODS A standardized care path was used to calculate the annual costs (per patient) and cost drivers of the Rheumatoid arthritis (RA) care cycle following the FL-TDABC methodology. Cost information (2018) was derived from hospital reports concerning financial, human resource and business intelligence data from a Dutch top clinical research hospital, Maasstad Hospital. Time estimates of procedures were obtained by interviewing the medical staff and relevant care activities were extracted from electronic health records. For analytical and validation purposes, FL-TDABC estimates were compared with TDABC and ABC cost estimates. RESULTS The RA care cycle annual costs totaled €1497 per patient (2018 prices) based on the FL-TDABC methodology. Maximum RA cycle costs (€1684) were some 22% higher than minimum costs (€1317) observed from FL-TDABC. Cost drivers explaining the cost variation are predominantly the number of consultations with rheumatologists and pharmacy costs related to RA. Based on TDABC and ABC, annual costs per patient were €1609 and €1604, respectively. CONCLUSIONS The FL-TDABC methodology offers a more precise and efficient estimate of care cycle costs, allowing for the subjective (fuzzy) nature of healthcare time estimates made by the medical staff. As a result, the FL-TDABC provides insight into the practice variation, and hence it can promote the transition from a volume-based system to a VBHC system.
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Affiliation(s)
- Fiona Koster
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands.
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands.
| | - Marc R Kok
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands
| | - Jaco van der Kooij
- Department of Finance and Control, Maasstad Hospital, Rotterdam, The Netherlands
| | - Geeke Waverijn
- Department of Business Intelligence, Maasstad Hospital, Rotterdam, The Netherlands
| | - Angelique E A M Weel-Koenders
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
| | - Deirisa Lopes Barreto
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands
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Singh M, Rathi R, Jaiswal A, Manishbhai SD, Gupta SS, Dewangan A. Empirical analysis of Lean Six Sigma implementation barriers in healthcare sector using fuzzy DEMATEL approach: an Indian perspective. TQM 2022. [DOI: 10.1108/tqm-05-2022-0152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PurposeThe present study aims to explore the barriers to Lean Six Sigma (LSS) implementation in the healthcare sector and develop the ranking of finalized barriers using the Decision-Making Trial and Evaluation Laboratory (DEMATEL) approach under a fuzzy environment.Design/methodology/approachThe LSS barriers are identified through the literature review and validated by the expert's opinion and statistical analysis. A total of 124 experts were identified through the purposive sampling method for conducting this study. A questionnaire survey method is used to collect the data related to identified LSS barriers in the healthcare sector. The screened barriers are ranked through the Fuzzy DEMATEL approach.FindingsIn this study, a total of 21 barriers were identified with the help of a systematic literature review and screened 13 significant barriers by the expert opinions of healthcare personnel. The result reveals that “Lack of top management commitment and support, lack of awareness about LSS”, “resistance to culture change and inadequate resources emerges as the most critical barriers”. The prioritization of barriers facilitates the managers to make effective policies and guidelines for LSS implementation in healthcare organizations.Practical implicationsTo avoid LSS implementation failure, the practitioners and researchers need to focus on LSS barriers as per suggested ranking more conventionally and make plans and adoption policies accordingly.Originality/valueThis study is unique in terms of investigation and empirical analysis of LSS implementation barriers in the healthcare sector in the Indian context. The outcomes of the present study will help the managers of healthcare organizations to make the strategies and policies for LSS implementation as per the recommended LSS barriers.
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Ahmed S, Hawarna S, Alqasmi I, Mohiuddin M, Rahman MK, Ashrafi DM. Role of Lean Six Sigma approach for enhancing the patient safety and quality improvement in the hospitals. International Journal of Healthcare Management 2022. [DOI: 10.1080/20479700.2022.2149082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Selim Ahmed
- World School of Business, World University of Bangladesh, Dhaka, Bangladesh
| | - Shatha Hawarna
- School of Business and Quality Management, Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates
| | - Ibrahim Alqasmi
- Public Health School of Health Sciences, Saudi Electronic University, Riyadh, Saudi Arabia
| | | | - Muhammad Khalilur Rahman
- Faculty of Entrepreneurship and Business, Angkasa-Umk Research Academy, Universiti Malaysia Kelantan, Pengkalan Chepa, Malaysia
| | - Dewan Mehrab Ashrafi
- ULAB School of Business, University of Liberal Arts Bangladesh, Dhaka, Bangladesh
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Gyllenhammar D, Hammersberg P. How to facilitate improvements in public service systems: propositions for action. IJQRM 2022. [DOI: 10.1108/ijqrm-09-2021-0314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PurposeThe purpose of this article is to increase the understanding of how improvements can be facilitated in a public service containing multiple actors in terms of identifying, aligning and prerequisites for the improvements.Design/methodology/approachThe research utilizes an interactive research approach where data were gathered though a conference, workshop and a survey. The study alternately combines quality management methods such as affinity and interrelationship diagrams with computer aided text mining and latent semantic analysis.FindingsThe research shows that practitioners must consider interconnectedness between improvements and benefits that are crossing organizational levels of the public service system as well as professional borders. In public service systems, the complex reality can be better understood when improvements and benefits are classified into different organizational layers and an interconnectedness and sequence of improvement areas are acknowledged.Research limitations/implicationsThe research is set in the Swedish public service of the tax-paid sick leave insurance. Future research would benefit by investigating similar cases in other nations and other services.Practical implicationsThe used methodology can be applied by practitioners to enhance a unified understanding of the system required to improve. The study also guides practitioners for how to support, relive hinders and prioritize improvements.Originality/valueThe research fills a gap of understanding of improvements in public services with multiple actors. As this area is difficult to improve, a novel combination of qualitative and quantitative methods paved the way for deeper and more unified understanding of the system.
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De Koeijer R, Strating M, Paauwe J, Huijsman R. A balanced approach involving hard and soft factors for internalizing Lean Management and Six Sigma in hospitals. TQM 2022. [DOI: 10.1108/tqm-01-2022-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThis study examines the theoretical and empirical relationships between LM&SS, human resource management (HRM), climate for LM&SS and outcomes (employee well-being and performance) in hospitals. As part of this research, the authors examine the interplay between “hard” and “soft” practices for LM&SS and “soft” HR practices.Design/methodology/approachA cross-sectional, multisite survey study covering all internal service units at all eight Dutch university hospitals was conducted (42 units, N = 218 supervisors, N = 1,668 employees), and multivariate multilevel regression analyses were performed.FindingsA systems approach involving “soft” LM&SS practices that are specifically HR-related has a positive effect (β is 0.46) on a climate for LM&SS. A climate for LM&SS is not related to perceived performance or employee health. It is, however, positively related to employee happiness and trusting relationships (both βs are 0.33). We did not find that a climate for LM&SS had a mediating effect.Research limitations/implicationsThis study shows that a balanced approach involving both “hard” and “soft” factors is crucial to achieving the desired breadth and depth of LM&SS adoption at the macro, meso, and micro levels. The authors found that a climate for LM&SS positively affects employee well-being in hospitals.Practical implicationsIn their attempt to create mutual gains for both their organization and their employees, hospitals that adopt LM&SS should foster a climate for LM&SS by embracing a balanced approach consisting of both “hard” and “soft” practices, thereby internalizing LM&SS at the macro, meso, and micro levels.Originality/valueThis is one of the first studies to examine in-depth the impact of “hard” and “soft” LM&SS on both employee well-being (subdivided into different components) and performance in healthcare, as well as the role of “soft” HRM in this relationship. Linking LM&SS, HRM and outcomes to a climate for LM&SS is relatively a new approach and has led to a deeper understanding of the mechanisms underpinning the internalization of LM&SS in healthcare.
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Bacelar-Silva GM, Cox JF, Rodrigues P. Achieving rapid and significant results in healthcare services by using the theory of constraints. Health Syst (Basingstoke) 2022; 13:48-61. [PMID: 38370321 PMCID: PMC10868449 DOI: 10.1080/20476965.2022.2115408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/12/2022] [Indexed: 10/15/2022] Open
Abstract
Lack of timeliness and capacity are seen as fundamental problems that jeopardise healthcare delivery systems everywhere. Many believe the shortage of medical providers is causing this timeliness problem. This action research presents how one doctor implemented the theory of constraints (TOC) to improve the throughput (quantity of patients treated) of his ophthalmology imaging practice by 64% in a few weeks with little to no expense. The five focusing steps (5FS) guided the TOC implementation - which included the drum-buffer-rope scheduling and buffer management - and occurred in a matter of days. The implementation provided significant bottom-line results almost immediately. This article explains each step of the 5FS in general terms followed by specific applications to healthcare services, as well as the detailed use in this action research. Although TOC successfully addressed the practice problems, this implementation was not sustained after the TOC champion left the organisation. However, this drawback provided valuable knowledge. The article provides insightful knowledge to help readers implement TOC in their environments to provide immediate and significant results at little to no expense.
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Affiliation(s)
- Gustavo M. Bacelar-Silva
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine (MEDCIDS-FMUP), University of Porto, Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
- Department of Distance Learning, Bahiana School of Medicine and Public Health, Salvador, Brazil
| | - James F. Cox
- Management Department, Terry College of Business,University of Georgia, Athens, Georgia, USA
| | - Pedro Rodrigues
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine (MEDCIDS-FMUP), University of Porto, Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
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Koemtzi MD, Psomas E, Antony J, Tortorella GL. Lean manufacturing and human resources: a systematic literature review on future research suggestions. Total Quality Management & Business Excellence 2022. [DOI: 10.1080/14783363.2022.2071256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Maria D. Koemtzi
- School of Social Sciences, Hellenic Open University, Patras, Greece
| | - Evangelos Psomas
- Department of Business Administration of Food and Agricultural Enterprises, University of Patras, Agrinio, Greece
| | - Jiju Antony
- Department of Industrial and Systems Engineering, Khalifa University, Abu Dhabi, UAE
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Sohal A, De Vass T, Vasquez T, Bamber GJ, Bartram T, Stanton P. Success factors for lean six sigma projects in healthcare. J Manag Control 2022. [DOI: 10.1007/s00187-022-00336-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AbstractIdentifying critical success factors (CSFs) of continuous improvement projects is crucial for management control and operations management domains. Despite the availability of manufacturing-related literature, studies on CSFs in more dynamic and complex healthcare-related operations are scarce. This study, based at a large public tertiary healthcare organization, identifies CSFs in implementing Lean Six Sigma (LSS). 62 LSS projects completed by Green Belts in consultation with Black Belts were analyzed for project success by a review team of practitioners (Black Belters) and academics. Using a grounded theory approach, numerous success factors were initially identified. A series of brainstorming sessions and workshops helped to narrow down and revise all the CSFs present in each of the 62 LSS projects to eight CSFs. The success of the 62 completed projects was assessed against each of the eight CSFs on a five-point Likert scale. Success was measured against whether the project met its stated aim and achieved the Key Performance Indicators that had initially been identified. Finally, the correlations of each factor rating against project success were analyzed to validate the relationship between each success factor and project success. The findings confirm that all eight CSFs identified are significantly correlated to project success. This study contributes to the management control, operations management, and healthcare literature by identifying CSFs of continuous improvement projects and introducing a relatively unique, rigorous, and practically proven evaluation method applied via an industry and academic partnership. Specified CSFs and the method used to identify these will benefit managers of continuous improvement projects.
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Pfeifer MR. SMEs in Automotive Supply Chains: A Survey on Six Sigma Performance Perceptions of Czech Supply Chain Members. Processes (Basel) 2022; 10:698. [DOI: 10.3390/pr10040698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Six sigma is understood as a technique for the continuous improvement in process quality; however, it has been rarely scientifically analysed in small- and medium-sized enterprises (SMEs). SMEs representthe vast majority of enterprises throughout economies and contribute to automotive supply chains in various tier ranks. As SMEs are known to lack resources and skills while focusing on short-term benefits rather than on long-term gradual improvements, the aim of of this paper is to analyse the perception of six sigma process capabilities in automotive supply chains assuming differences in company size, supply chain rank and six sigma duration. This was tested with Fisher’s exact test. Companies with less than 1000 employees, subsuppliers and companies with a six sigma implementation in the last 3 years struggled to meet six sigma principles, suggesting that mainly small companies inhibit a risk for the supply chain. These findings contribute to the existing theoretical body of knowledge by identifying a three-to-five-year period for six sigma implementations until six sigma maturity. Practically, the findings contribute to the research by explaining the need for a continuous supplier development over a three-to-five-year period until the company meets its performance requirements, with a supply chain risk incorporated in lower-tier ranks and with small companies.
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Vidal-carreras PI, Garcia-sabater JJ, Marin-garcia JA. Applying Value Stream Mapping to Improve the Delivery of Patient Care in the Oncology Day Hospital. IJERPH 2022; 19:4265. [PMID: 35409944 PMCID: PMC8998329 DOI: 10.3390/ijerph19074265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 11/16/2022]
Abstract
Improving the delivery of patient care is an ongoing challenge in the National Health Service (NHS). This challenge is not insignificant in the process of chemotherapy administration for oncology patients. The present research is motivated by a public Spanish hospital in which oncology patients receive medical care in the Oncology Day Hospital (ODH). At the ODH, oncology patients receive different health services by different specialists on a single day. Any discoordination in patient flow will contribute to longer waiting times and stays in the ODH. As oncology patients tend to have special health conditions, any extra time in the hospital is a source of risk and discomfort. This study applies value stream mapping methodology in a Spanish ODH to improve this situation, reducing hospital waiting times and shorting the length of stay. For that purpose, the path of the oncology patients is mapped and the current state of the system is analyzed. Working at takt time and levelling the workload are proposed for improving the working conditions for healthcare personnel. As a result, the quality of service for oncology patients who need a well-defined care profile is improved. The singular characteristics of the Spanish NHS make it challenging to implement new ways of working, so this study has significant theoretical and managerial implications offering directions in which improvement is possible.
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Daly A, Teeling SP, Garvey S, Ward M, McNamara M. Using a Combined Lean and Person-Centred Approach to Support the Resumption of Routine Hospital Activity following the First Wave of COVID-19. IJERPH 2022; 19:ijerph19052754. [PMID: 35270447 PMCID: PMC8910100 DOI: 10.3390/ijerph19052754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/19/2022] [Accepted: 02/23/2022] [Indexed: 11/16/2022]
Abstract
The unexpected advent of the COVID-19 pandemic led to a sudden disruption of routine medical care, with a subsequent reorganization of hospital structures and of care. Case studies are becoming available in the literature referring to the logistical difficulties involved in a hospital resuming normal activity following the first COVID-19 lockdown period. This paper details the experience of a study site, a private hospital in Dublin, Ireland, in the redesign of service delivery in compliance with new COVID-19 prevention regulations to facilitate the resumption of routine hospital activity following the first wave of COVID-19. The aim was to resume routine activity and optimize patient activity, whilst remaining compliant with COVID-19 guidelines. We employed a pre-/post-intervention design using Lean methodology and utilised a rapid improvement event (RIE) approach underpinned by person-centred principles. This was a system-wide improvement including all hospital staff, facilitated by a specific project team including the chief operation officer, allied therapy manager (encompassing health and social care professionals), infection prevention and control team, head of surgical services, clinical nurse managers, patient services manager and the head of procurement. Following our intervention, hospital services resumed successfully, with the initial service resumption meeting the organizational target of a 75% bed occupancy rate, while the number of resumed surgeries exceeded the target by 13%. Our outpatient visits recovered to exceed the attendance numbers pre-COVID-19 in 2019 by 10%. In addition, patient satisfaction improved from 93% to 95%, and importantly, we had no in-hospital patient COVID-19 transmission in the study period of July to December 2020.
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Affiliation(s)
- Ailish Daly
- Beacon Hospital, Beacon Court, Bracken Road, Sandyford Business Park, Sandyford, Dublin 18, D18 AK68 Dublin, Ireland;
- Correspondence:
| | - Sean Paul Teeling
- UCD Centre for Interdisciplinary Research, Education & Innovation in Health Systems, Midwifery & Health Systems, UCD Health Sciences Centre, School of Nursing, D04 V1W8 Dublin, Ireland; (S.P.T.); (M.M.)
- Centre for Person-Centred Practice Research, Division of Nursing, School of Health Sciences, Queen Margaret University, Musselburgh EH21 6UU, UK
| | - Suzanne Garvey
- Beacon Hospital, Beacon Court, Bracken Road, Sandyford Business Park, Sandyford, Dublin 18, D18 AK68 Dublin, Ireland;
| | - Marie Ward
- Centre for Innovative Human Systems, School of Psychology, Trinity College, The University of Dublin, D02 PN40 Dublin, Ireland;
| | - Martin McNamara
- UCD Centre for Interdisciplinary Research, Education & Innovation in Health Systems, Midwifery & Health Systems, UCD Health Sciences Centre, School of Nursing, D04 V1W8 Dublin, Ireland; (S.P.T.); (M.M.)
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Gyllenhammar D, Eriksson E, Eriksson H. Theory and practice of customer-related improvements: a systematic literature review. Total Quality Management & Business Excellence 2022. [DOI: 10.1080/14783363.2022.2038558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Daniel Gyllenhammar
- Department of Technology Management and Economics, Chalmers University of Technology, Gothenburg, Sweden
| | - Erik Eriksson
- Department of Technology Management and Economics, Chalmers University of Technology, Gothenburg, Sweden
| | - Henrik Eriksson
- Department of Technology Management and Economics, Chalmers University of Technology, Gothenburg, Sweden
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Rathi R, Vakharia A, Shadab M. Lean six sigma in the healthcare sector: A systematic literature review. Mater Today Proc 2022; 50:773-81. [PMID: 35155129 DOI: 10.1016/j.matpr.2021.05.534] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/05/2021] [Accepted: 05/08/2021] [Indexed: 11/21/2022]
Abstract
Healthcare is a very important sector as our lives depend on it. During the novel corona virus pandemic, it was evident that our healthcare organizations still lack in terms of efficiency and productivity. Especially in the developing nations, the problems were much bigger. Lean Six Sigma (LSS) is a methodology which when implemented in an organization, helps to increase the process capability and the efficiency, by reducing the defects and wastes. The present study systematically reviews the research studies conducted on LSS in the healthcare sector. It was found that comparatively less studies are focused on improving the medical processes, most of the studies targeted the management processes. Moreover, lesser number of studies were being conducted for developing nations, but now it seems that the focus of research scholars has shifted towards the developing nations also. But it was observed that the studies in these nations were majorly empirical in nature, very few studies were conceptual or exploratory. There is a need for guiding healthcare professionals on creating a continuous improvement environment, which sustains the improvements achieved after LSS implementation.
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Ward ME, Daly A, McNamara M, Garvey S, Teeling SP. A Case Study of a Whole System Approach to Improvement in an Acute Hospital Setting. Int J Environ Res Public Health 2022; 19:1246. [PMID: 35162269 DOI: 10.3390/ijerph19031246] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 11/16/2022]
Abstract
Changes in healthcare tend to be project-based with whole system change, which acknowledges the interconnectedness of socio-technical factors, not the norm. This paper attempts to address the question of whole system change posed by the special issue and brings together other research presented in this special issue. A case study approach was adopted to understand the deployment of a whole system change in the acute hospital setting along four dimensions of a socio-technical systems framework: culture, system functioning, action, and sense-making. The case study demonstrates evidence of whole system improvement. The approach to change was co-designed by staff and management, projects involving staff from all specialities and levels of seniority were linked to each other and to the strategic objectives of the organisation, and learnings from first-generation projects have been passed to second and third-generation process improvements. The socio-technical systems framework was used retrospectively to assess the system change but could also be used prospectively to help healthcare organisations develop approaches to whole system improvement.
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Hundal GS, Thiyagarajan S, Alduraibi M, Laux CM, Furterer SL, Cudney EA, Antony J. The impact of Lean Six Sigma practices on supply chain resilience during COVID 19 disruption: a conceptual framework. Total Quality Management & Business Excellence 2021. [DOI: 10.1080/14783363.2021.2014313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Gaganpreet Singh Hundal
- Department of Computer and Information Technology, Purdue University, West Lafayette, IN, USA
| | | | - Manal Alduraibi
- Department of Computer and Information Technology, Purdue University, West Lafayette, IN, USA
| | - Chad Matthew Laux
- Department of Computer and Information Technology, Purdue University, West Lafayette, IN, USA
| | - Sandra L. Furterer
- Department of Engineering Management, Systems and Technology, University of Dayton, Dayton, OH, USA
| | | | - Jiju Antony
- Department of Industrial and Systems Engineering, Khalifa University, Abu Dhabi, UAE
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Daly A, Wolfe N, Teeling SP, Ward M, McNamara M. Redesigning the Process for Scheduling Elective Orthopaedic Surgery: A Combined Lean Six Sigma and Person-Centred Approach. Int J Environ Res Public Health 2021; 18:ijerph182211946. [PMID: 34831703 PMCID: PMC8619232 DOI: 10.3390/ijerph182211946] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/02/2021] [Accepted: 11/09/2021] [Indexed: 11/16/2022]
Abstract
The Health Service Executive Ireland model of care for elective surgery supports the delivery of elective surgical care in achieving both process and clinical outcomes. This project was conducted in the Orthopaedic Department. Following an outpatient consultation with an orthopaedic surgeon, patients who required surgical intervention were scheduled for their intervention by the administrative team. Prior to commencing this project, the average time from patient consultation to being scheduled for surgery on the hospital system was 62 h/2.58 days. A pre- and post-team-based intervention design employing Lean Six Sigma methodology was applied to redesign the process for scheduling elective orthopaedic surgery. The project was informed by collaborative, inclusive, and participatory stakeholder engagement. The goal was to streamline the scheduling process for elective orthopaedic surgery, with a target that 90% of surgeries are scheduled “right first time” within 48 h/two working days of the outpatient consultant appointment. The main outcome measures showed that 100% of orthopaedic surgeries were scheduled successfully within 2 days of outpatient appointment. Duplication in work between patient services and scheduling teams was eliminated and facilitated a reduction in unnecessary staff workload. This project highlights the importance of collaborative interdisciplinary stakeholder engagement in the redesigning of processes to achieve sustainable outcomes, and the findings have informed further improvements across the hospital’s surgical scheduling system.
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Affiliation(s)
- Ailish Daly
- Beacon Hospital Beacon Court, Bracken Rd, Sandyford Business Park, Sandyford, D18 AK68 Dublin, Ireland;
- Correspondence:
| | - Nicola Wolfe
- Beacon Hospital Beacon Court, Bracken Rd, Sandyford Business Park, Sandyford, D18 AK68 Dublin, Ireland;
| | - Seán Paul Teeling
- UCD Centre for Interdisciplinary Research, Education & Innovation in Health Systems, School of Nursing, Midwifery & Health Systems UCD Health Sciences Centre, D04 V1W8 Dublin, Ireland; (S.P.T.); (M.M.)
- Centre for Person-Centered Practice Research Division of Nursing, School of Health Sciences, Queen Margaret University Drive, Musselburgh EH21 6UU, East Lothian, UK
| | - Marie Ward
- Centre for Innovative Human Systems, School of Psychology, Trinity College, The University of Dublin, D02 PN40 Dublin, Ireland;
| | - Martin McNamara
- UCD Centre for Interdisciplinary Research, Education & Innovation in Health Systems, School of Nursing, Midwifery & Health Systems UCD Health Sciences Centre, D04 V1W8 Dublin, Ireland; (S.P.T.); (M.M.)
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Crisan EL, Covaliu BF, Chis DM. A Systematic Literature Review of Quality Management Initiatives in Dental Clinics. Int J Environ Res Public Health 2021; 18:11084. [PMID: 34769604 PMCID: PMC8582852 DOI: 10.3390/ijerph182111084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/16/2021] [Accepted: 10/17/2021] [Indexed: 12/17/2022]
Abstract
By considering the recently proposed definitions and metrics, oral healthcare quality management (OHQM) emerges as a distinct field in the wider healthcare area. The goal of this paper is to systematically review quality management initiatives (QMIs) implementation by dental clinics. The research methodology approach is a review of 72 sources that have been analyzed using the Context-Intervention-Mechanism-Outcome Framework (CIMO). The analysis identifies five mechanisms that explain how quality management initiatives are implemented by dental clinics. The simplest QMIs implementations are related to (1) overall quality. The next ones, in terms of complexity, are related to (2) patient satisfaction, (3) service quality, (4) internal processes improvement, and (5) business outcomes. This paper is the first attempt to provide a critical review of this topic and represents an important advancement by providing a theoretical framework that explains how quality management is implemented by practitioners in this field. The results can be used by scholars for advancing their studies related to this emerging research area and by healthcare managers in order to better implement their quality management initiatives.
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Affiliation(s)
- Emil Lucian Crisan
- Faculty of Economics and Business Administration, Department of Management, Babes-Bolyai University, 400591 Cluj-Napoca, Romania;
| | - Bogdan Florin Covaliu
- Faculty of Medicine, Department of Community Medicine, Public Health and Management, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, 400337 Cluj-Napoca, Romania
| | - Diana Maria Chis
- Faculty of Economics and Business Administration, Department of Finance, Babes-Bolyai University, 400591 Cluj-Napoca, Romania;
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Daly A, Teeling SP, Ward M, McNamara M, Robinson C. The Use of Lean Six Sigma for Improving Availability of and Access to Emergency Department Data to Facilitate Patient Flow. Int J Environ Res Public Health 2021; 18:11030. [PMID: 34769548 DOI: 10.3390/ijerph182111030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/14/2021] [Accepted: 10/16/2021] [Indexed: 11/17/2022]
Abstract
The aim of this study was to redesign an emergency department [ED] data management system to improve the availability of, and access to, data to facilitate patient flow. A pre-/post-intervention design was employed using Lean Six Sigma methodology with a focus on the voice of the customer, Gemba, and 5S to identify areas for improvement in ED data management processes and to inform solutions for improved ED patient flow processes. A multidisciplinary ED team includes medical consultants and registrars, nurses, patient service staff, radiology staff, as well as information technology and hospital management staff. Lean Six Sigma [LSS] diagnostic tools identified areas for improvement in the current process for data availability and access. A set of improvements were implemented to redesign the pathway for data collection in the ED to improve data availability and access. We achieved a reduction in the time taken to access ED patient flow data from a mean of 9 min per patient pre-intervention to immediate post-intervention. This enabled faster decision-making by the ED team related to patient assessment and treatment and informed improvements in patient flow. Optimizing patient flow through a hospital’s ED is a complex task involving collaboration and participation from multiple disciplines. Through the use of LSS methodology, we improved the availability of, and fast access to, accurate, current information regarding ED patient flow. This allows ED and hospital management teams to identify and rapidly respond to actions impacting patient flow.
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Abstract
PURPOSE The paper aims at enriching the knowledge of the application of lean management (LM) in emergency department (ED), structuring the methodology for implementing LM projects and summarizing the relevant dimensions of LM adoption in ED. DESIGN/METHODOLOGY/APPROACH In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, a systematic literature review has been performed, extracting a database of 34 papers. To answer the research purpose, a descriptive and content analyses have been carried out. FINDINGS The descriptive analysis demonstrates that the dealt topic is worldwide emerging and multidisciplinary as it arouses interest by medical and engineering communities. Despite the heterogeneity in the adopted methodology, a framework can be grasped from the literature review. It points out the phases and activities, the tools and techniques and the enablers to be considered for guiding the developing of LM project in ED. ORIGINALITY/VALUE This paper provides a comprehensive overview on how to adopt LM in ED, contributing to fill in the gap emerged in the literature. From a practical perspective, this paper provides healthcare managers with a synthesis of the best managerial practices and guidelines in developing a LM project in ED.
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Affiliation(s)
- Anna Tiso
- Department of Management and Engineering, University of Padova, Padova, Italy
| | - Maria Crema
- Azienda ULSS N 2 Marca Trevigiana, Treviso, Italy
| | - Chiara Verbano
- Department of Management and Engineering, University of Padova, Padova, Italy
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Davidson JE, Chechel L, Chavez J, Olff C, Rincon T. Thematic Analysis of Nurses' Experiences With The Joint Commission's Medication Management Titration Standards. Am J Crit Care 2021; 30:375-384. [PMID: 34467388 DOI: 10.4037/ajcc2021280] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND For decades, medication titration has been within nurses' scope and practice. In 2017 The Joint Commission (TJC) revised elements for orders for the titration of continuous intravenous medications. OBJECTIVES To explore the practice and perceptions of nurses regarding TJC standards for titration of continuous intravenous medications. METHODS Nurses with experience titrating medications completed an investigator-designed, validated cross-sectional survey. Inductive thematic analysis was conducted in order to analyze the open-ended comments from that quantitative survey. RESULTS From among 730 completed surveys, 159 comments were received. Analysis of the comments yielded 3 levels of abstraction. Two overarching themes were harm and professionalism. Additional abstraction for the harm theme revealed categories of erosion of workplace wellness, moral dilemma, and patient safety, which were coded as relating to workplace stress, workload, burnout/turnover, physical risk, inefficiency, demeaning/devalued, falsification of records, problematic orders, burden of documentation, suboptimal care, delay in care, individualized care, and provider availability. Within the professionalism theme, categories of autonomy and nurse proficiency were identified, with 7 associated codes: top of scope, critical thinking, overregulation, teamwork, education, registered nurse knowledge, and novice registered nurse guidance. CONCLUSIONS The standards from TJC impose harm by eroding workplace wellness and introducing moral dilemmas and patient safety concerns. Professionalism is threatened through limits on scope and autonomy. Further advocacy is necessary in order to resolve unanticipated consequences related to the titration standards.
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Affiliation(s)
- Judy E. Davidson
- Judy E. Davidson is a nurse scientist, University of California San Diego Health, San Diego, California
| | - Laura Chechel
- Laura Chechel is manager of the cardiovascular intensive care unit, Sulpizio Cardiovascular Center, University of California San Diego Health, La Jolla, California
| | - Jose Chavez
- Jose Chavez is a clinical nurse specialist, Cedars-Sanai Medical Center, Los Angeles, California
| | - Carol Olff
- Carol Olff is the integrated director of critical care services, John Muir Health, Concord Medical Center, Concord, California
| | - Teresa Rincon
- Teresa Rincon is the director of clinical operations and innovation, UMass Memorial Health Care, and an assistant professor, University of Massachusetts Medical School, Graduate School of Nursing, Worcester, Massachusetts
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Rosa A, Marolla G, Lega F, Manfredi F. Lean adoption in hospitals: the role of contextual factors and introduction strategy. BMC Health Serv Res 2021; 21:889. [PMID: 34454500 PMCID: PMC8403367 DOI: 10.1186/s12913-021-06885-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 08/09/2021] [Indexed: 11/15/2022] Open
Abstract
Background In the scientific literature, many studies describe the application of lean methodology in the hospital setting. Most of the articles focus on the results rather than on the approach adopted to introduce the lean methodology. In the absence of a clear view of the context and the introduction strategy, the first steps of the implementation process can take on an empirical, trial and error profile. Such implementation is time-consuming and resource-intensive and affects the adoption of the model at the organizational level. This research aims to outline the role contextual factors and introduction strategy play in supporting the operators introducing lean methodology in a hospital setting. Methodology The methodology is revealed in a case study of an important hospital in Southern Italy, where lean has been successfully introduced through a pilot project in the pathway of cancer patients. The originality of the research is seen in the detailed description of the contextual elements and the introduction strategy. Results The results show significant process improvements and highlight the spontaneous dissemination of the culture of change in the organization and the streamlined adoption at the micro level. Conclusion The case study shows the importance of the lean introduction strategy and contextual factors for successful lean implementation. Furthermore, it shows how both factors influence each other, underlining the dynamism of the organizational system. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06885-4.
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Affiliation(s)
- Angelo Rosa
- Department of Management Studies, LUM University, S.S. 100 Km, 70010, Casamassima, Italy
| | - Giuliano Marolla
- Department of Management Studies, LUM University, S.S. 100 Km, 70010, Casamassima, Italy.
| | - Federico Lega
- Center in Health Administration, and Center for Applied Health Economics and Management of IRCCS Galeazzi, University of Milan, Via Giacomo Venezian, 1, 20133, Milan, Italy
| | - Francesco Manfredi
- Department of Management Studies, LUM University, S.S. 100 Km, 70010, Casamassima, Italy
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Hernández-Lara AB, Sánchez-Rebull MV, Niñerola A. Six Sigma in Health Literature, What Matters? Int J Environ Res Public Health 2021; 18:8795. [PMID: 34444542 DOI: 10.3390/ijerph18168795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 11/19/2022]
Abstract
Six Sigma has been widely used in the health field for process or quality improvement, constituting a quite profusely investigated topic. This paper aims at exploring why some studies have more academic and societal impact, attracting more attention from academics and health professionals. Academic and societal impact was addressed using traditional academic metrics and alternative metrics, often known as altmetrics. We conducted a systematic search following the PRISMA statement through three well-known databases, and identified 212 papers published during 1998–2019. We conducted zero-inflated negative binomial regressions to explore the influence of bibliometric and content determinants on traditional academic and alternative metrics. We observe that the factors influencing alternative metrics are more varied and difficult to apprehend than those explaining traditional impact metrics. We also conclude that, independently of how the impact is measured, the paper’s content, rather than bibliometric characteristics, better explains its impact. In the specific case of research on Six Sigma applied to health, the papers with more impact address process improvement focusing on time and waste reduction. This study sheds light on the aspects that better explain publications’ impact in the field of Six Sigma application in health, either from an academic or a societal point of view.
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McAdam R, Galbraith B, McComb S, Antony J, Vijaya Sunder M. Development of Sustainable Lean Patient Value in Healthcare: A Long-Term Condition Context. Total Quality Management & Business Excellence 2021. [DOI: 10.1080/14783363.2021.1964357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Rodney McAdam
- Ulster University Business School, Ulster University, Jordanstown, UK
| | - Brendan Galbraith
- Ulster University Business School, Ulster University, Jordanstown, UK
- College of Business, Zayed University, Abu Dhabi, UAE
| | - Stephen McComb
- Ulster University Business School, Ulster University, Jordanstown, UK
| | - Jiju Antony
- Edinburgh Business School, Heriot-Watt University, Edinburgh, UK
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de Barros LB, Bassi LDC, Caldas LP, Sarantopoulos A, Zeferino EBB, Minatogawa V, Gasparino RC. Lean Healthcare Tools for Processes Evaluation: An Integrative Review. Int J Environ Res Public Health 2021; 18:7389. [PMID: 34299840 PMCID: PMC8304063 DOI: 10.3390/ijerph18147389] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/02/2021] [Accepted: 07/07/2021] [Indexed: 11/24/2022]
Abstract
Several health services have used lean healthcare to seek continuous improvement of their processes. Therefore, it is important to investigate the evidence available in the literature about the most used lean tools in the health area to review processes and the main results achieved by the researchers. As an integrative literature review methodology was used, it was conducted in five databases, using the descriptor "quality improvement" and the keyword "Lean Healthcare". A total of 33 complete articles were selected for analysis. The most recurrent tools were: define, measure, analyze, improve and control (DMAIC); value stream map (VSM); suppliers, inputs, process, outputs, customers analysis (SIPOC), Ishikawa Diagram and 5S. Through the analysis of waste, different interventions were implemented and the main results achieved were reduction in times (processing, waiting, cycle and total), costs, workload and increase in the number of calls. The findings enabled the identification of the main lean tools used in the health area to achieve better results. In particular, we highlight recent studies that have explored the lean six sigma healthcare approach. The results, in addition to contributing to the literature, will also assist managers in choosing the best tool to achieve continuous improvement in hospitals and other health services.
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Affiliation(s)
| | - Letícia de Camargo Bassi
- School of Nursing, University of Campinas, Campinas 13083-887, Brazil; (L.d.C.B.); (L.P.C.); (R.C.G.)
| | - Laura Passos Caldas
- School of Nursing, University of Campinas, Campinas 13083-887, Brazil; (L.d.C.B.); (L.P.C.); (R.C.G.)
| | - Alice Sarantopoulos
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas 13083-887, Brazil;
| | | | - Vinicius Minatogawa
- Escuela de Ingeniería en Construcción, Pontificia Universidad Católica de Valparaíso, Valparaíso 2340000, Chile;
| | - Renata Cristina Gasparino
- School of Nursing, University of Campinas, Campinas 13083-887, Brazil; (L.d.C.B.); (L.P.C.); (R.C.G.)
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Abstract
PURPOSE Lean-inspired approaches and performance management systems are being implemented in public healthcare organisations internationally. However, the literature is inconclusive regarding the benefits of these management tools and there is a lack of knowledge regarding processes for large-scale implementation of these tools. This article aims to describe the implementation process and to better understand how this process influences the mandated performance management system. DESIGN/METHODOLOGY/APPROACH This research is based on a comparative case study of three healthcare organisations in Canada. Data consist documents, non-participant observation and semi-structured interviews with key actors (n = 30). Analysis is based on a sociotechnical approach to management tools that considers organisational context, and the tool's technical substrate, theory of action and managerial philosophy. FINDINGS Results show that despite a standardised national mandate, the tool as implemented varied between organisations in terms of technical substrate and managerial philosophy. These variations are explained by the flexibility of the technical substrate, the lack of clarity of the managerial philosophy, and some contextual elements. Successful implementation may rest upon high hybridization of the tool on these different dimensions. A precise and prescribed technical substrate is not sufficient to guarantee implementation of a managerial philosophy. PRACTICAL IMPLICATIONS Mandated implementation of management tools may be more successful if it is explicit on the managerial philosophy, the technical substrate and the link between the two, and if it provides some leeway to adapt both to the organisational context. ORIGINALITY/VALUE This is one of the few studies to describe and analyse the process involved in mandated large-scale implementation of performance management systems in public healthcare organisations.
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Affiliation(s)
| | - Mylaine Breton
- Faculty of Medicine and Health Sciences, University of Sherbrooke, Longueuil, Canada
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Abstract
PurposeWorldwide, healthcare systems struggle to sustain the delivery of services at a time of increasing demand, limited resources and growing expectations from users, coupled with dealing with the aftermath of the Covid-19 pandemic and the threat of other outbreaks. There has never been a more important time to sustain innovation and improvements. Using an illustrative case, the authors assess the application of two existing frameworks to identify the key propositions and dimensions required to deliver sustainable services.Design/methodology/approachThis illustrative case study focuses on a service provided by a chronic disease, multidisciplinary community healthcare team in the UK. Experienced-based interviews were conducted with health professionals, patients and relatives to provide a rich account of a care pathway design. A high-level process map is used to visualise the key touch points.FindingsThe authors identify all seven propositions of the SERVICE framework being present along with additional dimensions relating to sustaining innovation and improvement.Research limitations/implicationsThis research is limited to a chronic disease care pathway. However, the authors believe the results could be applicable to other medical conditions, which are supported by a similar multi-disciplinary service delivery model.Practical implicationsThe authors provide a sustainable public service operations SERVICES framework for health professionals and managers to consider when (re)designing care pathways.Originality/valueThis research contributes to the emerging discipline of public service operations research by empirically testing for the first time the SERVICE framework within healthcare. The authors have included additional factors associated with innovation and improvement and recommended further development of the framework to include factors, such as economic sustainability, highly relevant to the context of universal healthcare systems.
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Antonsen Y, Bye G. Line managers and employees use of lean task boards in Norwegian municipal healthcare sector: a tool for action learning? Leadersh Health Serv (Bradf Engl) 2020; 33:445-460. [PMID: 33635025 DOI: 10.1108/lhs-04-2020-0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This study aims to analyse the line managers and employees' use of lean task boards over time in Norwegian municipalities using action learning theory. The research question was the following: what kind of action learning processes do the line managers and employees' use of the lean task board promote in municipalities' healthcare units? DESIGN/METHODOLOGY/APPROACH This qualitative case study data from a Norwegian municipality involved analyses of 750 internal self-recorded logs from task board sessions from 6 different units and 25 semi-structured interviews of managers and employees. FINDINGS The task board works for line managers to make employees responsible for forwarding ideas, solutions and implementation of new actions. The use of the task boards contributes to systemising work through establishing new routines and improving orderliness at work. The line managers used the task boards as a project management system to track progress in the purchasing of diverse equipment and initiatives to improve professionalism and their units' facilities. The study explains the learning challenges for managers using the lean task board, as the method promotes finding experience-based solutions that do not involve critical reflection and use of theory. PRACTICAL IMPLICATIONS The lean task board is well-suited for managers to promote learning processes that counteract chaos in local healthcare organisations. However, the task board has limitations as a method for improving services amongst healthcare units and for solving difficult problems. ORIGINALITY/VALUE The study contributes to understanding how action learning theory can be applied to the analysis of the results of lean task board sessions.
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Affiliation(s)
- Yngve Antonsen
- Department of Education, Faculty of Humanities, Social Sciences and Education, UiT The Arctic University of Norway, Tromso, Norway
| | - Geir Bye
- NORCE Norwegian Research Centre AS, Tromsø, Norway
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Swarnakar V, Singh A, Tiwari AK. Evaluating the effect of critical failure factors associated with sustainable Lean Six Sigma framework implementation in healthcare organization. IJQRM 2020; 38:1149-77. [DOI: 10.1108/ijqrm-07-2020-0243] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe purpose of this study is to develop a structured hierarchical interrelationship-based model to evaluate the critical failure factors (CFFs) that affect the sustainable Lean Six Sigma (SLSS) framework implementation in a healthcare organization. Further, solution approaches have been provided that guide to eliminate them.Design/methodology/approachThe CFFs has been identified through empirical study and clustered into six major categories for their better understanding. The interrelation among CFFs has been developed through total interpretive structural modeling (TISM) and classifies the nature using MICMAC technique. Further, prioritized the CFFs based on its driving and dependents power. The methodology enabled the decision-makers, practitioners to systematically analyze the CFFs and develop a structural model for implementing SLSS in the healthcare environment.FindingsA total of 14 leading CFFs have been identified, and 7-level structured interrelationship-based model has been formed. The experts have provided the solution approach after careful analysis of the developed model. Based on the analysis, it was observed that the significant CFFs affect the deployment of the SLSS framework in healthcare organizations.Research limitations/implicationsThe structured model and methodological approach have been tested in a healthcare organization. In the future, the approach can be applied in the different service sectors.Practical implicationsThe present study has been conducted in a real-time industrial problem. The practitioners, decision-makers and academicians expressed the usefulness of methodology for understanding the CFFs interrelation and their effect on SLSS implementation. This study also guides decision-makers to systematically tackle related problems.Originality/valueThe development of a structured CFFs based model for SLSS framework implementation using the integrated TISM-MICMAC with a detailed solution approach is a unique effort in a healthcare environment.
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Abdallah AA. Healthcare Engineering: A Lean Management Approach. J Healthc Eng 2020; 2020:8875902. [PMID: 33082927 DOI: 10.1155/2020/8875902] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 06/05/2020] [Accepted: 09/21/2020] [Indexed: 12/01/2022]
Abstract
This work tries to answer the following question: can healthcare be engineered using lean management tools? Lean is known to achieve successful results when implemented in the manufacturing sector. Typical results are operational cost reduction, cycle time reduction, and higher customer satisfaction. The service sector, however, has seen mixed results. For the last two decades, educators and healthcare professionals are trying to implement lean tools in healthcare. Some reported success and many did not, for variety of reasons. In this paper, we search the literature and reveal the special nature of healthcare services, success factors, and barriers facing implementation of lean in healthcare. We then conduct a survey of 18 elite Jordanian hospitals to study the case holistically. Statistical analysis of the survey results confirmed some of what the literature revealed; organizational leadership seems to be the most dominant factor, followed by knowledge of employees about lean, training, and patient satisfaction (customer focus). Another important finding, not captured by the literature, is that lean implementation success depends on educating physicians about continuous improvement and lean and ensuring they are part of the improvement team. Based on the revealed enablers and obstacles, we created a full lean implementation framework. This framework was then used along with selected engineering tools to implement lean in a major hospital successfully. Implementation results showed 60% of reduction in cycle time, 80% reduction in operational cost, and many other benefits.
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Fernandes HMDLG, Jesus MVND, Silva DD, Guirardello EDB. Lean Healthcare in the institutional, professional, and patient perspective: an integrative review. ACTA ACUST UNITED AC 2020; 41:e20190340. [PMID: 32813807 DOI: 10.1590/1983-1447.2020.20190340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 04/28/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To analyze the scientific evidences in the literature about the evaluation of Lean Healthcare after its implementation. METHOD An integrative review conducted in the CINAHL, Scopus, WOS, and Embase databases, and in the PubMed portal, resulting in 18 articles published in English, Spanish and Portuguese, from 2008 to 2019. RESULTS The findings were categorized into results for the institution, professional, and patient. The predominant category was institutional, with cost analysis and increased productivity, followed by the professional, with job satisfaction and leadership, and finally the patient, with satisfaction, attitudes, and behaviors. CONCLUSION This study reinforces the need to establish, for management, a systematic method of monitoring the results achieved in the Lean Healthcare implementation phase. Since the value in this method is defined by the patient, further research in this aspect may lead to new evidence.
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Affiliation(s)
| | - Mariana Véo Nery de Jesus
- Programa de Pós Graduação em Enfermagem, Faculdade de Enfermagem, Universidade Estadual de Campinas, Campinas, São Paulo, Brasil
| | - Dirceu da Silva
- Faculdade de Educação, Universidade Estadual de Campinas, Campinas, São Paulo, Brasil
| | - Edinêis de Brito Guirardello
- Programa de Pós Graduação em Enfermagem, Faculdade de Enfermagem, Universidade Estadual de Campinas, Campinas, São Paulo, Brasil
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Zepeda-Lugo C, Tlapa D, Baez-Lopez Y, Limon-Romero J, Ontiveros S, Perez-Sanchez A, Tortorella G. Assessing the Impact of Lean Healthcare on Inpatient Care: A Systematic Review. Int J Environ Res Public Health 2020; 17:ijerph17155609. [PMID: 32759705 PMCID: PMC7432925 DOI: 10.3390/ijerph17155609] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/23/2020] [Accepted: 07/29/2020] [Indexed: 12/16/2022]
Abstract
Healthcare services are facing challenges in increasing their efficiency, quality of care, and coping with surges in demand. To this end, some hospitals have implemented lean healthcare. The aim of this systematic review is to evaluate the effects of lean healthcare (LH) interventions on inpatient care and determine whether patient flow and efficiency outcomes improve. The review was performed according to PRISMA. We used six databases to search for studies published from 2002 to 2019. Out of 5732 studies, 39 measuring one or more defined outcomes were included. Hospital length of stay (LOS) was measured in 23 studies, 16 of which reported a reduction, turnover time (TOT) decreased in six out of eight studies, while the turnaround time (TAT) and on-time starts (OTS) improved in all five and seven studies, respectively. Moreover, eight out of nine studies reported an earlier discharge time, and the boarding time decreased in all four cases. Meanwhile, the readmission rate did not increase in all nine studies. Lastly, staff and patient satisfaction improved in all eight studies. Our findings show that by focusing on reducing non-value-added activities, LH contributed to improving patient flow and efficiency within inpatient care.
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Affiliation(s)
- Carlos Zepeda-Lugo
- Facultad de Ingeniería, Arquitectura y Diseño, Universidad Autónoma de Baja California, Ensenada 22860, Mexico; (C.Z.-L.); (J.L.-R.)
| | - Diego Tlapa
- Facultad de Ingeniería, Arquitectura y Diseño, Universidad Autónoma de Baja California, Ensenada 22860, Mexico; (C.Z.-L.); (J.L.-R.)
- Correspondence: (D.T.); (Y.B.-L.); Tel.: +52-6461750744 (D.T.)
| | - Yolanda Baez-Lopez
- Facultad de Ingeniería, Arquitectura y Diseño, Universidad Autónoma de Baja California, Ensenada 22860, Mexico; (C.Z.-L.); (J.L.-R.)
- Correspondence: (D.T.); (Y.B.-L.); Tel.: +52-6461750744 (D.T.)
| | - Jorge Limon-Romero
- Facultad de Ingeniería, Arquitectura y Diseño, Universidad Autónoma de Baja California, Ensenada 22860, Mexico; (C.Z.-L.); (J.L.-R.)
| | - Sinue Ontiveros
- Facultad de Ciencias de la Ingeniería, Administrativas y Sociales, Universidad Autónoma de Baja California, Tecate 21460, Mexico;
| | - Armando Perez-Sanchez
- Facultad de Ciencias de la Ingeniería y Tecnología, Universidad Autónoma de Baja California, Tijuana 22260, Mexico;
| | - Guilherme Tortorella
- Department of Systems and Production Engineering, Universidade Federal de Santa Catarina, Florianópolis 88040, Brazil;
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Gaikwad SK, Paul A, Moktadir MA, Paul SK, Chowdhury P. Analyzing barriers and strategies for implementing Lean Six Sigma in the context of Indian SMEs. BIJ 2020. [DOI: 10.1108/bij-11-2019-0484] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe purpose of this study is to investigate the barriers for implementing Lean Six Sigma (LSS) in small and medium-sized enterprises (SMEs) and present a framework that provides prioritized strategies to overcome the barriers.Design/methodology/approachThe barriers and strategies are identified via a comprehensive literature review and validated by industry experts. The study uses the fuzzy Technique for Order of Preference by Similarity to Ideal Solution (fuzzy TOPSIS) to analyze the barriers and strategies for determining the prioritized list of strategies.FindingsThe findings reveal that there are sixteen barriers to LSS implementation in Indian SMEs. To overcome these barriers, this study reveals twelve strategies. The analysis shows that “effective management” is the most crucial strategy to overcome the barriers for implementing LSS in Indian SMEs.Research limitations/implicationsThis research guides SMEs practitioners to efficiently and effectively implement LSS, which, in turn, can enhance the performance of SMEs.Originality/valueThis study contributes to the literature by integrating the strategies with the barriers for implementing LSS in Indian SMEs. Besides, this study provides the prioritized list of strategies to overcome the barriers for implementing LSS in Indian SMEs.
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Ricciardi C, Sorrentino A, Improta G, Abbate V, Latessa I, Perrone A, Triassi M, Dell'aversana Orabona G. A health technology assessment between two pharmacological therapies through Six Sigma: the case study of bone cancer. TQM 2020; 32:1507-24. [DOI: 10.1108/tqm-01-2020-0013] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeHead and neck cancers are multi-factorial diseases that can affect many sides of people's life and are due to a lot of risk factors. According to their characteristics, the treatment can be surgical, use of radiation or chemotherapy. The use of a surgical treatment can lead to surgical infections that are a main theme in medicine. At the University hospital of Naples “Federico II”, two antibiotics were employed to tackle the issue of the infections and they are compared in this paper to find which one implies the lowest length of hospital stay (LOS) and the reduction of infections.Design/methodology/approachThe Six Sigma methodology and its problem-solving strategy DMAIC (define, measure, analyse, improve, control), already employed in the healthcare sector, were used as a tool of a health technology assessment between two drugs. In this paper the DMAIC roadmap is used to compare the Ceftriaxone (administered to a group of 48 patients) and the association of Cefazolin plus Clindamycin (administered to a group of 45 patients).FindingsThe results show that the LOS of patients treated with Ceftriaxone is lower than those who were treated with the association of Cefazolin plus Clindamycin, the difference is about 41%. Moreover, a lower number of complications and infections was found in patients who received Ceftriaxone. Finally, a greater number of antibiotic shifts was needed by patients treated with Cefazolin plus Clindamycin.Research limitations/implicationsWhile the paper enhances clearly the advantages for patients' outcomes regarding the LOS and the number of complications, it did not analyse the costs of the two antibiotics.Practical implicationsEmploying the Ceftriaxone would allow the Department of Maxillofacial Surgery to obtain lower LOS and a limited number of complications/infections for recovered patients, consequently reducing the hospitalization costs.Originality/valueThere is a double value in this paper: first of all, the comparison between the two antibiotics gives an answer to one of the main issues in medicine that is the reduction of hospital-acquired infections; secondly, the Six Sigma through its DMAIC cycle can be employed also to compare two biomedical technologies as a tool of health technology assessment studies.
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Hohmeier KC, Shelton C, Havrda D, Gatwood J. The need to prioritize "prioritization" in clinical pharmacy service practice and implementation. Res Social Adm Pharm 2020; 16:1785-1788. [PMID: 32414658 DOI: 10.1016/j.sapharm.2020.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 04/11/2020] [Indexed: 11/28/2022]
Abstract
Pharmacists are increasingly asked to incorporate new and greater amounts of clinical services into their traditional medication distribution responsibilities, but many barriers exist. Given the demanding pharmacy practice environment, improved time management may improve implementation rates. One area not previously explored within this area is the clinical skill of "prioritization" of medication related problems (MRPs). Prioritization is vital as the workload demand for pharmacist time exceeds time available; however, the underdeveloped skills of prioritizing is a concern in the field of pharmacy practice, as it also is across professions in healthcare. Previous research has suggested that pharmacists and student pharmacists inexperienced in implementing clinical services struggle knowing where to begin when providing direct patient care, given the complex patient care regimens, a complex pharmacy practice workload, and the numerous preventative care interventions possible for a given patient. This paper provides a review of theory and science of prioritization in patient care service delivery, including Multicriteria Decision Analysis (MCDA), Lean Six Sigma (LSS), and Jaen's Competing Demands framework. A case study is shared which emphasizes both the need for and potential impact of a renewed focus on workload management skills, such as prioritization.
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Affiliation(s)
- Kenneth C Hohmeier
- University of Tennessee Health Science Center, College of Pharmacy, 301 S Perimeter Park Drive, Suite 220, Nashville, TN, 37211, USA.
| | - Chasity Shelton
- University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue Memphis, TN, 38103, USA
| | - Dawn Havrda
- University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue Memphis, TN, 38103, USA
| | - Justin Gatwood
- University of Tennessee Health Science Center, College of Pharmacy, 301 S Perimeter Park Drive, Suite 220, Nashville, TN, 37211, USA
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Hernandez C, Lopez JJ, Melnyc R, Friedman M, Gitlow H. Six Sigma for home health care: Applying theories & methodologies. International Journal of Healthcare Management 2019. [DOI: 10.1080/20479700.2019.1621021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Pandhi N, Kraft S, Berkson S, Davis S, Kamnetz S, Koslov S, Trowbridge E, Caplan W. Developing primary care teams prepared to improve quality: a mixed-methods evaluation and lessons learned from implementing a microsystems approach. BMC Health Serv Res 2018; 18:847. [PMID: 30413205 PMCID: PMC6230270 DOI: 10.1186/s12913-018-3650-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 10/24/2018] [Indexed: 11/29/2022] Open
Abstract
Background Health systems in the United States are increasingly required to become leaders in quality to compete successfully in a value-conscious purchasing market. Doing so involves developing effective clinical teams using approaches like the clinical microsystems framework. However, there has been limited assessment of this approach within United States primary care settings. Methods This paper describes the implementation, mixed-methods evaluation results, and lessons learned from instituting a Microsystems approach across 6 years with 58 primary care teams at a large Midwestern academic health care system. The evaluation consisted of a longitudinal survey augmented by interviews and focus groups. Structured facilitated longitudinal discussions with leadership captured ongoing lessons learned. Quantitative analysis employed ordinal logistic regression and compared aggregate responses at 6-months and 12-months to those at the baseline period. Qualitative analysis used an immersion/crystallization approach. Results Survey results (N = 204) indicated improved perceptions of: organizational support, team effectiveness and cohesion, meeting and quality improvement skills, and team communication. Thematic challenges from the qualitative data included: lack of time and coverage for participation, need for technical/technology support, perceived devaluation of improvement work, difficulty aggregating or spreading learnings, tensions between team and clinic level change, a part-time workforce, team instability and difficulties incorporating a data driven improvement approach. Conclusions These findings suggest that a microsystems approach is valuable for building team relationships and quality improvement skills but is challenged in a large, diverse academic primary care context. They additionally suggest that primary care transformation will require purposeful changes implemented across the micro to macro-level including but not only focused on quality improvement training for microsystem teams.
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Affiliation(s)
- Nancy Pandhi
- Department of Family and Community Medicine, University of New Mexico School of Medicine, MSC 09 5040, 1 University of New Mexico, Albuquerque, NM, 87131, USA.
| | - Sally Kraft
- Population Health at Geisel School of Medicine at Dartmouth College, 1 Rope Ferry Rd, Hanover, NH, 03755, USA.,Primary Care Academics Transforming Healthcare Collaborative, Madison, WI, USA
| | - Stephanie Berkson
- Primary Care Academics Transforming Healthcare Collaborative, Madison, WI, USA.,Planning and Business Development, UW Health, Madison, WI, USA
| | - Sarah Davis
- Primary Care Academics Transforming Healthcare Collaborative, Madison, WI, USA.,University of Wisconsin Law School, Madison, WI, USA.,Center for Patient Partnerships, Madison, WI, USA
| | - Sandra Kamnetz
- Primary Care Academics Transforming Healthcare Collaborative, Madison, WI, USA.,Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Steven Koslov
- Primary Care Academics Transforming Healthcare Collaborative, Madison, WI, USA.,Department of Pediatric and Adolescent Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Elizabeth Trowbridge
- Primary Care Academics Transforming Healthcare Collaborative, Madison, WI, USA.,General Internal Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - William Caplan
- Primary Care Academics Transforming Healthcare Collaborative, Madison, WI, USA.,General Internal Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Al-Farsi YM, Al-Balushi SM. Go Lean, Get Leaner: The application of lean management in Omani healthcare. Sultan Qaboos Univ Med J 2018; 18:e431-e432. [PMID: 30988959 PMCID: PMC6443269 DOI: 10.18295/squmj.2018.18.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/19/2019] [Accepted: 02/21/2019] [Indexed: 06/09/2023] Open
Affiliation(s)
- Yahya M. Al-Farsi
- Department of Family Medicine & Public Health, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Shahid M. Al-Balushi
- Department of Operations Management & Business Statistics, College of Economics & Political Science, Sultan Qaboos University, Muscat, Oman
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