1
|
Al Harbi S, Aljohani B, Elmasry L, Baldovino FL, Raviz KB, Altowairqi L, Alshlowi S. Streamlining patient flow and enhancing operational efficiency through case management implementation. BMJ Open Qual 2024; 13:e002484. [PMID: 38423585 PMCID: PMC10910643 DOI: 10.1136/bmjoq-2023-002484] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 02/11/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Improving patient flow in hospitals represents a worldwide healthcare challenge. The objective of this project was to depict the effectiveness of case management in improving patient flow in a tertiary hospital setting. METHODS Quality improvement methods, including quantitative pre-Lean and post-Lean design, the Plan-Do-Check-Act concept, the Single Minute Exchange of Dies and the 'demand and supply approach' of the Institute of Healthcare Improvement, were adapted to examine and modify factors influencing hospital patient flow. RESULTS This study (conducted from the last quarter of 2019 through September 2022) resulted in a remarkable improvement in patient flow, as evident from the reduction in average hospital length of stay (from 11.5 to 4.4 days) and average emergency department boarding time (from 11.9 to 1.2 hours) and the improvement of bed turnover rate (from 0.57 to 0.93), (p<0.001, p=0.017, p=0.038, respectively), with net cost savings of 123 130 192 million Saudi Riyals (US$32 821 239). CONCLUSION Implementing a well-structured case management programme can enhance care coordination, streamlilne transitions, boost patient outcomes, and increase revenues within hospital settings.
Collapse
Affiliation(s)
- Sultanah Al Harbi
- Case Management Department, Al Hada Armed Forces Hospital, Taif, Makkah, Saudi Arabia
| | - Baker Aljohani
- Medical Administration, Al Hada Armed Forces Hospital, Taif, Makkah, Saudi Arabia
| | - Lamiaa Elmasry
- Quality Improvement and Patient Safety Department, Al Hada Armed Forces Hospital, Taif, Makkah, Saudi Arabia
| | - Frenk Lee Baldovino
- Case Management Department, Al Hada Armed Forces Hospital, Taif, Makkah, Saudi Arabia
| | - Kamille Bianca Raviz
- Case Management Department, Al Hada Armed Forces Hospital, Taif, Makkah, Saudi Arabia
| | - Lama Altowairqi
- Admission Office Department, Al Hada Armed Forces Hospital, Taif, Makkah, Saudi Arabia
| | - Seetah Alshlowi
- Case Management Department, Al Hada Armed Forces Hospital, Taif, Makkah, Saudi Arabia
| |
Collapse
|
2
|
Verga M, Viganò GL, Capuzzo M, Duri C, Ignoti LM, Picozzi P, Cimolin V. The digitization process and the evolution of Clinical Risk Management concept: The role of Clinical Engineering in the operational management of biomedical technologies. Front Public Health 2023; 11:1121243. [PMID: 36817927 PMCID: PMC9932586 DOI: 10.3389/fpubh.2023.1121243] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 01/17/2023] [Indexed: 02/05/2023] Open
Abstract
Introduction Digital transformation and technological innovation which have influenced several areas of social and productive life in recent years, are now also a tangible and concrete reality in the vast and strategic sector of public healthcare. The progressive introduction of digital technologies and their widespread diffusion in many segments of the population undoubtedly represent a driving force both for the evolution of care delivery methods and for the introduction of new organizational and management methods within clinical structures. Methods The CS Clinical Engineering of the "Spedali Civili Hospital in Brescia" decided to design a path that would lead to the development of a software for the management of biomedical technologies within its competence inside the hospital. The ultimate aim of this path stems from the need of Clinical Engineering Department to have up-to-date, realistic, and systematic control of all biomedical technologies present in the company. "Spedali Civili Hospital in Brescia" is not just one of the most important corporate realities in the city, but it is also the largest hospital in Lombardy and one of the largest in Italy. System development has followed the well-established phases: requirement analysis phase, development phase, release phase and evaluating and updating phase. Results Finally, cooperation between the various figures involved in the multidisciplinary working group led to the development of an innovative management software called "SIC Brescia". Discussion The contribution of the present paper is to illustrate the development of a complex implementation model for the digitization of processes, information relating to biomedical technologies and their management throughout the entire life cycle. The purpose of sharing this path is to highlight the methodologies followed for its realization, the results obtained and possible future developments. This may enable other realities in the healthcare context to undertake the same type of pathway inspired by an accomplished model. Furthermore, future implementation and data collection related to the proposed Key Performance Indicators, as well as the consequent development of new operational management models for biomedical technologies and maintenance processes will be possible. In this way, the Clinical Risk Management concept will also be able to evolve into a more controlled, safe, and efficient system for the patient and the user.
Collapse
Affiliation(s)
- Matteo Verga
- ASST Spedali Civili di Brescia - SC Ingegneria Clinica, Brescia, Italy
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Gian Luca Viganò
- ASST Spedali Civili di Brescia - SC Ingegneria Clinica, Brescia, Italy
| | - Martina Capuzzo
- ASST Spedali Civili di Brescia - SC Ingegneria Clinica, Brescia, Italy
| | - Claudia Duri
- ASST Spedali Civili di Brescia - SC Ingegneria Clinica, Brescia, Italy
| | | | - Paola Picozzi
- ASST Spedali Civili di Brescia - SC Ingegneria Clinica, Brescia, Italy
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Veronica Cimolin
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
- S. Giuseppe Hospital, Istituto Auxologico Italiano, IRCCS, Piancavallo, Italy
| |
Collapse
|
3
|
Saeed HM, Saad Elghareeb A, El-Hodhod MAA, Samy G. Assessment of COVID-19 preparedness response plan on higher education students simulation of WHO intra-action review in Egypt. Sci Rep 2023; 13:741. [PMID: 36639553 PMCID: PMC9839230 DOI: 10.1038/s41598-023-27713-1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 01/06/2023] [Indexed: 01/15/2023] Open
Abstract
Because of the COVID-19 outbreak, Mass gathering restrictions were imposed. The lockdown of the Higher Education Institutions was obligatory to save lives. In February 2021 in Egypt, HEIs were allowed to ease the lockdown restrictions on a case-by-case basis gradually. In this paper, we propose a risk evaluation of planned regular mass gathering events during the pandemic, such as students gathering on-campus during indoor exams, by implementing WHO COVID-19 Strategic Preparedness and Response Plan through Intra-Action Review guidance. This one-group posttest-only design study was done on October 6 University campus during indoor students' exams in Giza, Egypt. We conducted IAR to implement the WHO's COVID- 19 SPRP; Country-level coordination; risk communication; surveillance, rapid response teams; points of entry; infection prevention control; laboratories; supply chain; case management; essential health services, and other possible topics. Between February-21, 2021; April-10, 2021, 25,927 students attended the on-campus living exams. Our result suggests that the high level of Readiness-Capacity during mass gatherings will reduce COVID-19 transmission. The most compelling evidence is the significance of synchronization between the ten pillars in preventing COVID-19 transmission. These findings may be used to influence decision-making for continual improvement of the operational planning guidelines during the outbreaks.
Collapse
Affiliation(s)
| | | | | | - Gamal Samy
- October 6 University, 6th of October City, Giza, Egypt
| |
Collapse
|
4
|
Abstract
Processes to enhance customer-related services in healthcare organizations are complex and it can be difficult to achieve efficient patient-focused services. Laboratories make an integral part of the healthcare service industry where healthcare providers deal with critical patient results. Errors in these processes may cost a human life, create a negative impact on an organization's reputation, cause revenue loss, and open doors for expensive lawsuits. To overcome these complexities, healthcare organizations must implement an approach that helps healthcare service providers to reduce waste, variation, and work imbalance in the service processes. Lean and Six Sigma are used as continuous process improvement frameworks in laboratory medicine. Six Sigma uses an approach that involves problem-solving, continuous improvement and quantitative statistical process control. Six Sigma is a technique based on the DMAIC process (Define, Measure, Analyze, Improve, and Control) to improve quality performance. Application of DMAIC in a healthcare organization provides guidance on how to handle quality that is directed toward patient satisfaction in a healthcare service industry. The Lean process is a technique for process management in which waste reduction is the primary purpose; this is accomplished by implementing waste mitigation practices and methodologies for quality improvement. Overall, this article outlines the frameworks for continuous quality and process improvement in healthcare organizations, with a focus on the impacts of Lean and Six Sigma on the performance and quality service delivery system in clinical laboratories. It also examines the role of utilization management and challenges that impact the implementation of Lean and Six Sigma in clinical laboratories.
Collapse
Affiliation(s)
- Vinita Thakur
- Department of Laboratory Medicine, Health Sciences Center, Eastern Health Authority, St. John's, Canada.,Faculty of Medicine, Memorial University of Newfoundland, St. John's, Canada
| | - Olatunji Anthony Akerele
- Department of Laboratory Medicine, Health Sciences Center, Eastern Health Authority, St. John's, Canada
| | - Edward Randell
- Department of Laboratory Medicine, Health Sciences Center, Eastern Health Authority, St. John's, Canada.,Faculty of Medicine, Memorial University of Newfoundland, St. John's, Canada
| |
Collapse
|
5
|
La Forgia D, Paparella G, Signorile R, Arezzo F, Comes MC, Cormio G, Daniele A, Fanizzi A, Fioretti AM, Gatta G, Lafranceschina M, Rizzo A, Zaccaria GM, Rosa A, Massafra R. Lean Perspectives in an Organizational Change in a Scientific Direction of an Italian Research Institute: Experience of the Cancer Institute of Bari. Int J Environ Res Public Health 2022; 20:239. [PMID: 36612562 PMCID: PMC9819426 DOI: 10.3390/ijerph20010239] [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] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/14/2022] [Accepted: 12/16/2022] [Indexed: 06/17/2023]
Abstract
Lean management is a relatively new organizational vision transferred from the automotive industry to the healthcare and administrative sector based on analyzing a production process to emphasize value and reduce waste. This approach is particularly interesting in a historical moment of cuts and scarcity of economic resources and could represent a low-cost organizational solution in many production companies. In this work, we analyzed the presentation and the initial management of current ministerial research projects up to the approval by the Scientific Directorate of an Italian research institute. Furthermore, the initial mode in 2021 ("as is") and the potential mode ("to be") according to a Lean model are studied, according to the current barriers highlighted by the final users of the process and carrying out some perspective analyses with some reference indicators.
Collapse
Affiliation(s)
- Daniele La Forgia
- I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy
| | - Gaetano Paparella
- I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy
| | - Rahel Signorile
- I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy
| | - Francesca Arezzo
- I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy
| | - Maria Colomba Comes
- I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy
| | - Gennaro Cormio
- I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy
- Department of Interdisciplinary Medicine, University of Bari, 70124 Bari, Italy
| | - Antonella Daniele
- I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy
| | - Annarita Fanizzi
- I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy
| | - Agnese Maria Fioretti
- I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy
| | - Gianluca Gatta
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Miria Lafranceschina
- I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy
| | - Alessandro Rizzo
- I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy
| | - Gian Maria Zaccaria
- I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy
| | - Angelo Rosa
- Department of Management, Finance and Technology, LUM University, 70010 Casamassima, Italy
| | - Raffaella Massafra
- I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Viale Orazio Flacco 65, 70124 Bari, Italy
| |
Collapse
|
6
|
Huang C, Lee D, Chen S, Tang W. A Lean Manufacturing Progress Model and Implementation for SMEs in the Metal Products Industry. Processes (Basel) 2022; 10:835. [DOI: 10.3390/pr10050835] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
The manufacturing industry faces the challenge of small and diversified customer orders. To meet this challenge, strong internal production capabilities are required. A lean manufacturing process that uses fewer resources and offers greater process improvement will help SMEs to continue to contribute to the global economy. Though SMEs provide most employment opportunities, previous studies have focused on large companies in auto-manufacturing-related industries. With the commitment and support of the management, and the application of a value stream map (VSM) and related improvement tools, we produced a practical process improvement model for a lean manufacturing system in an SME. With the commitment and support of the management and the joint efforts of the project improvement staff, the 10 improvement projects over a six-month period all achieved their goals: reduction in lead time from 26 days to 19.5 days, improvement of welding per people per hour (PPH) efficiency by 28.3%, improvement of packaging PPH efficiency by 64.1%, improvement of working in process (WIP) efficiency at the production site by 83.84%, and improvement of raw material storage by 83.84%. The efficiency of the raw material warehouse inventory was improved by 58.63%, and the efficiency of the shipment completion rate was improved by 14.5%.
Collapse
|
7
|
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.
Collapse
|
8
|
Gur I, Shapira S, Halloun N, Kaisari S, Stern A. Implementing Lean Techniques to Increase the Efficiency of a Rural Primary Care Clinic: A Prospective Controlled Study. Jt Comm J Qual Patient Saf 2022. [DOI: 10.1016/j.jcjq.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 01/26/2022] [Accepted: 01/26/2022] [Indexed: 11/24/2022]
|
9
|
Abstract
In recent years, the e-commerce market has grown significantly, and the online retail market has become very competitive. Online retailers strive to improve their supply chain operations to reduce costs and to improve customer satisfaction. Value stream mapping (VSM), a tool created by the lean production movement to identify and reduce errors, losses, and lead time and to improve value-added activities, has been proven to be effective in many manufacturing processes. In this study, we investigate the application of value stream mapping (VSM) in the supply chain of an e-commerce retailer on Amazon. By visualizing the entire supply chain with VSM, the waste that is produced during the delivery process from the retailer to the customer was identified. The five whys method was then applied to find the root cause of the waste. Furthermore, a scoring method was developed to evaluate and compare two different supply chain logistic models to identify a strategy for improvement. This study provides a systematic methodology to understand, evaluate, and improve the entire e-commerce supply chain process utilizing VSM. It was demonstrated that the methodology could improve supply chain management efficiency, customer satisfaction, and cost reduction.
Collapse
|
10
|
Apostu SA, Vasile V, Veres C. Externalities of Lean Implementation in Medical Laboratories. Process Optimization vs. Adaptation and Flexibility for the Future. Int J Environ Res Public Health 2021; 18:12309. [PMID: 34886029 PMCID: PMC8657048 DOI: 10.3390/ijerph182312309] [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: 09/30/2021] [Revised: 11/12/2021] [Accepted: 11/21/2021] [Indexed: 11/17/2022]
Abstract
Important in testing services in medical laboratories is the creation of a flexible balance between quality-response time and minimizing the cost of the service. Beyond the different Lean methods implemented so far in the medical sector, each company can adapt the model according to its needs, each company has its own specifics and organizational culture, and Lean implementation will have a unique approach. Therefore, this paper aims to identify the concerns of specialists and laboratory medical services sector initiatives in optimizing medical services by implementing the Lean Six Sigma method in its various variants: a comparative analysis of the implemented models, with emphasis on measuring externalities and delimiting trends in reforming/modernizing the method, a comprehensive approach to the impact of this method implementation, and an analysis of available databases in order to underline the deficit and information asymmetry. The results highlighted that in the case of clinical laboratories, the Lean Six Sigma method is conducive to a reduction of cases of diagnostic errors and saves time but also faces challenges and employees' resistance in implementation.
Collapse
Affiliation(s)
- Simona Andreea Apostu
- Department of Statistics and Econometric, Faculty of Cybernetics, Statistics and Economic Informatics, Bucharest University of Economic Studies, 010552 Bucharest, Romania
- Institute of National Economy-Romanian Academy, 050711 Bucharest, Romania;
| | - Valentina Vasile
- Institute of National Economy-Romanian Academy, 050711 Bucharest, Romania;
| | - Cristina Veres
- Industrial Engineering and Management Department, Faculty of Engineering and Information Technology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania;
| |
Collapse
|
11
|
Wu MF, Li JY, Lin YH, Huang WC, He CC, Wang JM. Processing Cycle Efficiency to Monitor the Performance of an Intelligent Tube Preparation System for Phlebotomy Services. Int J Environ Res Public Health 2021; 18:9386. [PMID: 34501976 DOI: 10.3390/ijerph18179386] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 07/14/2021] [Revised: 09/01/2021] [Accepted: 09/01/2021] [Indexed: 11/17/2022]
Abstract
Background: The waiting time (WT) for a phlebotomy is directly related to patient satisfaction with a health service. However, the processing time varies widely depending on the type of patients. Monitoring of the WT alone may not enable an effective evaluation of the lean performance of the medical staff for patients with different characteristics. The objective of this study was to use process cycle efficiency (PCE) to assess the performance of an intelligent tube preparation system (ITPS) which automatically labeled test tubes and conducted patient rerouting for phlebotomy services, and to interpret the WT during peak hours. Methods: Three time periods were used. The baseline period was from 1 July to 31 July 2014. Phase 1 was after the establishment of the ITPS, with patients ≥80 years old being rerouted. In phase 2, patients ≥78 years old were rerouted. Those data were recorded with a calling system and ITPS, respectively. Results: PCE was significantly improved from 12.9% at baseline to 51.1% (p < 0.001) in phase 1 and 53.0% (p < 0.001) in phase 2. The WT of 16.9 min at baseline was reduced to 3.8 min in phase 1 (p < 0.001), and 3.6 min in phase 2 (p < 0.001). Moreover, the results showed that a WT < 10 min was consistent with a PCE ≥ 25%. Conclusions: Establishing an ITPS for phlebotomy can significantly increase PCE and shorten the WT. Furthermore, the PCE ≥ 25% could be a good assessment reference for the management of appropriate human resources for phlebotomy services, although it is a complex parameter.
Collapse
|
12
|
Le DX, Do HT, Bui KT, Hoang TQ, Nguyen GH, Nguyen AV, Nguyen QT, Gorgui-Naguib H, Naguib RNG. Lean management for improving hospital waiting times-Case study of a Vietnamese public/general hospital emergency department. Int J Health Plann Manage 2021; 37:156-170. [PMID: 34490656 DOI: 10.1002/hpm.3310] [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: 05/18/2021] [Revised: 07/20/2021] [Accepted: 08/16/2021] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Emergency departments (EDs) at public hospitals in Vietnam typically face problems with overcrowding, as well as being populated by a wide variety of illnesses, resulting in increasing dissatisfaction from patients. To alleviate these problems, we used the increasingly popular value-stream mapping (VSM) and lean strategy approaches to (1) evaluate the current patient flow in EDs; (2) identify and eliminate the non-valued-added components; and (3) modify the existing process in order to improve waiting times. METHODS Data from a total of 742 patients who presented at the ED of 108 Military Central Hospital in Hanoi, Vietnam, were collected. A VSM was developed where improvement possibilities were identified and attempts to eliminate non-value-added activities were made. A range of issues that were considered as a resource waste were highlighted, which led to a re-design process focusing on prioritizing blood tests and ultrasound procedures. On the administrative side, various measures were considered, including streamlining communication with medical departments, using QR codes for healthcare insurance payments, and efficient management of X-ray and CT scan online results. RESULTS By implementing a lean approach, the following reductions in delay and waiting time were incurred: (1) pre-operative test results (for patients requiring medical procedures/operations) by 33.3% (from 134.4 to 89.4 min); (2) vascular interventions by 10.4% (from 54.6 to 48.9 min); and (3) admission to other hospital departments by 49.5% (from 118.3 to 59.8 min). Additionally, prior to the implementation of the lean strategy approach, only 22.9% of patients or their proxies (family members or friends), who responded to the survey, expressed satisfaction with the ED services. This percentage increased to 76.5% following the curtailment of non-value-added activities. Through statistical inferential test analyses, it can be confidently concluded that applying lean strategy and tools can improve patient flow in public/general hospital EDs and achieve better staff coordination within the various clinical and administrative hospital departments. To the authors' knowledge, such analysis in a Vietnamese hospital's ED context has not been previously undertaken.
Collapse
Affiliation(s)
- Duong X Le
- 108 Military Central Hospital, Hanoi, Vietnam
| | - Hoa T Do
- 108 Military Central Hospital, Hanoi, Vietnam
| | - Khoa T Bui
- 108 Military Central Hospital, Hanoi, Vietnam
| | | | | | - Anh V Nguyen
- Faculty of Business Administration & Management, Dai Nam University, Hanoi, Vietnam
| | - Quynh T Nguyen
- Faculty of Business Administration & Management, Dai Nam University, Hanoi, Vietnam.,Department of Mathematics & Statistics, Langara College, Vancouver, Canada
| | | | - Raouf N G Naguib
- School of Mathematics, Computer Science & Engineering, Liverpool Hope University, Liverpool, UK
| |
Collapse
|
13
|
Fiorillo A, Sorrentino A, Scala A, Abbate V, Dell'aversana Orabona G. Improving performance of the hospitalization process by applying the principles of Lean Thinking. TQM 2021. [DOI: 10.1108/tqm-09-2020-0207] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PurposeThe goal was to improve the quality of the hospitalization process and the management of patients, allowing the reduction of costs and the minimization of the preoperative Length of Hospital Stay (LOS).Design/methodology/approachThe methodology used to improve the quality of the hospitalization process and patient management was Lean Thinking. Therefore, the Lean tools (Value stream map and Ishikawa diagram) were used to identify waste and inefficiencies, improving the process with the implementation of corrective actions. The data was collected through personal observations, patient interviews, brainstorming and from printed medical records of 151 patients undergoing oral cancer surgery in the period from 2006 to 2018.FindingsThe authors identified, through Value Stream Map, waste and inefficiencies during preoperative activities, consequently influencing preoperative LOS, considered the best performance indicator. The main causes were identified through the Ishikawa diagram, allowing reflection on possible solutions. The main corrective action was the introduction of the pre-hospitalization service. A comparative statistical analysis showed the significance of the solutions implemented. The average preoperative LOS decreased from 4.90 to 3.80 days (−22.40%) with a p-value of 0.001.Originality/valueThe methodology allowed to highlight the improvement of the patient hospitalization process with the introduction of the pre-hospitalization service. Therefore, by adopting the culture of continuous improvement, the flow of hospitalization was redrawn. The benefits of the solutions implemented are addressed to the patient in terms of lower LOS and greater service satisfaction and to the hospital for lower patient management costs and improved process quality. This article will be useful for those who need examples on how to apply Lean tools in healthcare.
Collapse
|
14
|
Marin-Garcia JA, Bonavia T. Empowerment and Employee Well-Being: A Mediation Analysis Study. Int J Environ Res Public Health 2021; 18:5822. [PMID: 34071574 DOI: 10.3390/ijerph18115822] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/25/2021] [Accepted: 05/26/2021] [Indexed: 12/27/2022]
Abstract
This study examines the relationship between structural and psychological empowerment and its effects on employees’ psychological, physical, and social well-being. Despite the quantity of previously published works, empirical evidence about these relationships in the workplace is scarce. We developed a mediation model in which structural empowerment predicts employee well-being via psychological empowerment. We based our study on the EU-27 data from the 6th European Working Conditions Survey (EWCS). Data were collected from a questionnaire administered face-to-face to a random sample of employees and the self-employed representative of the working population in the European Union (number of valid responses in this study: 23,468). The effects of the relationships among the variables considered were evaluated using Partial Least Squares (PLS). Results indicate that structural empowerment was positively related to psychological empowerment, which was positively related to job satisfaction, work engagement, and social well-being. The expected relationships for work stress and physical well-being were not found.
Collapse
|
15
|
Morell-Santandreu O, Santandreu-Mascarell C, Garcia-Sabater JJ. A Model for the Implementation of Lean Improvements in Healthcare Environments as Applied in a Primary Care Center. Int J Environ Res Public Health 2021; 18:ijerph18062876. [PMID: 33799752 PMCID: PMC7998616 DOI: 10.3390/ijerph18062876] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 02/24/2021] [Revised: 03/06/2021] [Accepted: 03/08/2021] [Indexed: 12/12/2022]
Abstract
Companies operate in a competitive and changing environment requiring increasingly effective and efficient management strategies. Lean is a proven philosophy in the industrial sector having helped companies to adapt to rapid market changes; to economic, technical, and social complexities; and to customer needs. For this reason, companies in the service sector are adopting Lean to improve their service management and to achieve economic, social, and environmental sustainability. This paper presents a model which uses Lean tools to facilitate the introduction of Lean in the management of primary care centers. The results show the implementation of Lean improved primary care center management, achieved stated objectives, and demonstrated faster adaptation to environmental needs and changes. The Lean philosophy developed and applied in the primary care center proved useful at a professional level facilitating developmental changes and prompting lasting improvements by developing a sustainable work culture.
Collapse
|