Anna Tiso, Caterina Pozzan, Manuel Francisco Morales Contreras and Chiara Verbano
Facing the burden of chronic diseases has become a priority for health-care systems’ economic and social sustainability. To this end, this paper aims to focus on adopting Health…
Abstract
Purpose
Facing the burden of chronic diseases has become a priority for health-care systems’ economic and social sustainability. To this end, this paper aims to focus on adopting Health Lean Management (HLM), a widely used managerial approach, to improve the performance and quality of care provided in chronic care pathways. HLM addresses not only efficiency and timeliness issues but also care effectiveness and integration. Indeed, the lack of continuity and co-ordination of care constitutes a major challenge for chronic pathways. This research provides an innovative contribution, by extending the implementation of HLM to chronic pathways developed across hospital and territorial care. Indeed, HLM scope typically regards hospital units and departments; hence, analysing the interaction between different levels of care represents a novelty from an academic and practical perspective.
Design/methodology/approach
With the aim of understanding how to extend the adoption of HLM towards the territory, an action research project has been developed. In particular, an improvement project focused on breast cancer care pathways has been launched in a Spanish hospital. The research investigates which HLM activities, tools and practices need to be accomplished in this kind of project, grasping insights into emerging wastes. To this end, the HLM project followed the Define, Measure, Analyse, Improve and Control (DMAIC) cycle, supporting the project team in effectively conducting a preliminary context analysis, qualitative and quantitative data collection, the current state analysis and the countermeasure proposals.
Findings
The analysis conducted on the breast cancer care pathway highlighted major criticalities in managing the diagnosis of new patients. In particular, waiting times to obtain diagnostic imaging and breast specialist consultations highly impacted the care pathway effectiveness and efficiency. Specific wastes that caused these delays have been investigated, leading to the definition of specific countermeasures that could minimise the inefficiencies: an 85% reduction of the staging process lead time was estimated.
Originality/value
The achieved results contribute to enhancing the quality of care delivered to breast cancer patients. This paper enriches the theoretical knowledge about HLM, extending its typical field of application; provides practical support to health-care providers, managers and leaders with a case demonstrating how to develop HLM projects adopting the DMAIC cycle; and finally, it has valuable social implications, addressing the global threat of chronic disease.
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Anna Tiso, Maria Crema and Chiara Verbano
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…
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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Looks at the first 100 years of Italian cinema examining its role in Italy’s recent history. Provides a bibliography of major film directors, Italian cinema sources, reference…
Abstract
Looks at the first 100 years of Italian cinema examining its role in Italy’s recent history. Provides a bibliography of major film directors, Italian cinema sources, reference works, histories, themes, theory and criticism and articles in journals.
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Andrei Bonamigo, Gabriel Nascimento Santos, Sandra Maria do Amaral Chaves and Robisom Damasceno Calado
This study aims to analyse the setup time management using the single-minute exchange of die (SMED) method in 24 h Emergency Care Units (ECUs).
Abstract
Purpose
This study aims to analyse the setup time management using the single-minute exchange of die (SMED) method in 24 h Emergency Care Units (ECUs).
Design/methodology/approach
A total of 1,098 reports in A3 form format were analysed and grouped into analysis categories to evaluate the implications of SMED in managing setup time in the 24 h ECUs. The content analysis was based on Bardin (2011). The findings were grouped into three categories.
Findings
The findings demonstrate the contributions of the Lean Healthcare approach in the 24 h ECUs through SMED analysis to reduce setup time in activities characterised as waste in 24 h UPAs.
Research limitations/implications
In this study, data were collected directly from the Good Practices Application, from a specific project conducted in ECUs, which could generate selection bias. Finally, the datas were categorised according to the categories defined a posteriori, which may lead to interpretation bias.
Practical implications
The implications listed from the SMED perspective for setup time management allow us to guide managers, consultants, researchers, and health professionals to provide continuous improvement in 24 h ECUs. The findings can serve as a basis for reducing configuration time in other public and private healthcare service organisations.
Social implications
SMED applied in 24 h ECUs makes it possible to improve emergency services provided to society and increase the capacity to care for patients and society in general. In addition, reducing costs for health service financiers, such as government and private institutions.
Originality/value
To the best of the authors’ knowledge, this is the first study that correlates the setup time management of the SMED method in crucial areas of 24 h ECUs, demonstrating opportunities for its application in reducing time in patient journeys. The findings show the benefits of Lean in these environments and highlight several opportunities for applying SMED to reduce setup in activities characterised as waste in 24 h UPA. SMED allows for improved operational excellence in emergency units and enables target opportunities to increase user satisfaction and service capacity.