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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Maria Crema and Chiara Verbano
In a context where healthcare systems have to face multiple challenges, the development of a methodology that combines new managerial approaches could contribute to pursue and…
Abstract
Purpose
In a context where healthcare systems have to face multiple challenges, the development of a methodology that combines new managerial approaches could contribute to pursue and achieve multiple objectives. Inside the research stream that intends to combine health lean management (HLM) and clinical risk management (CRM), the purpose of this paper is to study the significant features that characterize HLM projects obtaining patient safety improvements (L&S projects).
Design/methodology/approach
The novelty of the research implies to adopt qualitative research methodology, analyzing in-depth case studies. L&S projects at different organizational levels have been selected from the same hospital. Following a research protocol, data have been collected through semi-structured interviews and they have been triangulated studying reports and archival documentation.
Findings
Comparing the three cases, it emerges that HLM can be a support for CRM since safety improvements can be achieved solving organizational issues. Analyzing the significant features of the three cases, relevant differences have been highlighted among them. At the end, first indications useful for achieving safety improvements from lean project implementation have been grasped.
Originality/value
This research provides a preliminary contribution to a new research stream that aims to develop a synergic methodology combining HLM and CRM. The first provided indications can be followed by hospital managers who wish to learn how to implement projects achieving patient safety improvements besides efficiency enhancement. After testing and exploiting the obtained results, a new methodology should be developed moving toward a safer and more sustainable healthcare system.
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Luis Mendes and Grazielle França
Healthcare organizations have been facing challenges due to high costs and low efficiency in health services. The growth of costs and losses caused by avoidable mistakes lead to…
Abstract
Purpose
Healthcare organizations have been facing challenges due to high costs and low efficiency in health services. The growth of costs and losses caused by avoidable mistakes lead to the search for solutions, and Health Lean Management appears as a potential solution to help in solving service quality problems, as well as reducing risks. This study aims to analyse the state of the art in the literature centred on the Lean approach in the context of risk management in healthcare organizations, and to identify new research opportunities, highlighting possible lines of future research.
Design/methodology/approach
Following a systematic literature review approach, 51 papers were considered relevant for this research, and reviewed to explore the development of literature in this area.
Findings
Based on the results, five main research streams were identified: (1) risk management oriented towards patient safety; (2) risk management oriented towards employee safety; (3) importance of attitudes and behaviours in risk reduction projects; (4) Lean tools used in healthcare risk management and (5) Integration of approaches. Moreover, several shortcomings were identified in literature.
Originality/value
Identified shortcomings represent significant opportunities for further research development.
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Maria Crema, Chiara Verbano and Maria Laura Chiozza
The purpose of this paper is to investigate the significant features that characterize these projects: organizational aspects, phases and activities, tools, techniques, practices…
Abstract
Purpose
The purpose of this paper is to investigate the significant features that characterize these projects: organizational aspects, phases and activities, tools, techniques, practices and key factors for successful implementation. No studies in the academic literature have yet focused on the relation between healthcare lean management (HLM) and clinical risk management (CRM) to enhance multiple aspects of performance, although the possibility of implementing “lean & safety” projects has been highlighted.
Design/methodology/approach
Two significant projects have been selected from the same Italian hospital in two different fields of application. Within- and cross-case analyses have been performed to obtain useful findings.
Findings
The results suggest that HLM can provide support for CRM, and an integrated methodology should be considered. The first indications concerning how this new synergistic methodology may be developed are provided and these should stimulate future research, testing and exploiting the methodology in other contexts.
Originality/value
From the results of this paper, guidelines for the implementation of a “lean & safety” project could be developed to improve the management of clinical processes pursuing multiple objectives. This study could contribute to the development of safer and more sustainable health care systems for the benefit of the entire community.
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Maria Crema and Chiara Verbano
The purpose of this paper is to describe the Italian state of art of Health Lean Management (HLM) and to analyze the Italian projects that connect this approach with clinical risk…
Abstract
Purpose
The purpose of this paper is to describe the Italian state of art of Health Lean Management (HLM) and to analyze the Italian projects that connect this approach with clinical risk management (CRM).
Design/methodology/approach
After introducing Italian healthcare system and its main challenges, relevant Italian experiences have been searched investigating regional health plans (RHPs), managerial reports, books, workshops, conference proceedings and hospital web sites. The degree of experience of each Italian region has been first studied. Further, field of applicability, objectives, tools, practices and results of the projects with first signs of HLM and CRM integration have been analyzed.
Findings
Although interest in new managerial approaches is spreading in almost all the territory and new managerial solutions are fostered in many RHPs, HLM projects are implemented patchy in Italy. For what regards HLM projects with CRM connections, the Italian context seems aligned with the international one, apart from few features. First indications for the implementation of HLM projects with CRM connections emerged.
Originality/value
Healthcare systems are facing multiple challenges in a context where public funds decrease but quality of care must be guaranteed. Combining different managerial approaches could solve these issues. In this research, for the first time, a map about Italian HLM adoption has been drawn, and Italian HLM projects with CRM connections have been analyzed. The results constitute one of the first contributions useful to develop guidelines for the implementation of projects pursuing efficiency, quality and safety objectives.
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Maria Crema, Chiara Verbano and Karen Venturini
The purpose of this paper is to analyze the linkages between company’s strategy, open innovation and innovation performance, focusing on small and medium enterprises (SMEs). In…
Abstract
Purpose
The purpose of this paper is to analyze the linkages between company’s strategy, open innovation and innovation performance, focusing on small and medium enterprises (SMEs). In more detail, the aim is to investigate the influence of firm strategy on the level of openness adopted and then the impact of open innovation on firm performance. Finally, the influence of context-specific variables (such as firm size, technology intensity, geographical area, experience of the company and technology turbulence) on the relations mentioned above will be verified.
Design/methodology/approach
A survey has been conducted in the Italian manufacturing context and a database of 107 responses was obtained. The constructs of the research framework were created and validated using factor analysis; further, structural equation modeling was performed to verify the hypothesis about the studied relations.
Findings
The obtained model confirmed most of the relations hypothesized, giving useful indications on how to define competitive strategy and coherent level of open innovation to pursue improved firm performance. Results highlight that firms, which pursue an innovative strategy are those who invest more on technical skills and core competencies. Companies who choose a strategy of diversification are likely to use, exclusively, managerial practices of open innovation, while firms focused on a strategy of efficiency are inclined toward open innovation practices and, to a lesser extent, to the development of core competencies.
Originality/value
The main original contribution is the development of an integrated model that links company’s strategy, open innovation and innovation performance in SMEs.
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Maria Crema and Chiara Verbano
The purpose of this paper is to investigate connections and overlaps between health lean management (HLM) and clinical risk management (CRM) understanding whether and how these…
Abstract
Purpose
The purpose of this paper is to investigate connections and overlaps between health lean management (HLM) and clinical risk management (CRM) understanding whether and how these two approaches can be combined together to pursue efficiency and patient safety improvements simultaneously.
Design/methodology/approach
A systematic literature review has been carried out. Searching in academic databases, papers that focus not only on HLM, but also on clinical errors and risk reduction, were included. The general characteristics of the selected papers were analysed and a content analysis was conducted.
Findings
In most of the papers, pursing objectives of HLM and CRM and adopting tools and practices of both approaches, results of quality and, particularly, of safety improvements were obtained. A two-way arrow between HLM and CRM emerged but so far, none of the studies has been focused on the relationship between HLM and CRM.
Originality/value
Results highlight an emerging research stream, with many useful theoretical and practical implications and opportunities for further research.
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Chiara Verbano and Maria Crema
Energy commodities are characterised by rigid demand and high price volatility, linked to many variables such as climate factors, exchange rates, availability of resources. At the…
Abstract
Purpose
Energy commodities are characterised by rigid demand and high price volatility, linked to many variables such as climate factors, exchange rates, availability of resources. At the same time, the authorities often set prices, so wholesale energy companies need to create margins carefully by managing the procurement process and selecting appropriate tools to manage the risks associated with the volatility of energy prices. The purpose of this paper is to analyse and evaluate price and volume risks in the energy procurement process considering a “non-speculative” point of view, which is understudied in the literature review.
Design/methodology/approach
The paper adopts a quantitative approach to risk evaluation, based on accounting indicators, and applies it to a large Italian energy wholesale company.
Findings
A set of key risk indicators to measure price and volume risks is presented in the results, split into synthesis risk, unbalanced risks, modulation risks and risks derived from bilateral contracts. These indicators are applied to the case study, and each risk is prioritised and discussed.
Originality/value
This contribution is one of the first attempts to analyse energy procurement risks in a non-speculative approach. The proposed method allows: first, to evaluate and prioritise the three major types in the energy procurement process, second, to observe the trend of risk exposure, third, the performance measurement of the procurement process, and fourth, benchmarking activities if widely implemented in the energy sector.
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In the past decades, Dutch public sector organizations (PSOs) have been encouraged to become more “business-like” in their internal control and accountability processes, following…
Abstract
Purpose
In the past decades, Dutch public sector organizations (PSOs) have been encouraged to become more “business-like” in their internal control and accountability processes, following a more general trend toward New Public Management (NPM) in Western societies. However, in the Netherlands, this trend has met with increasing resistance and discontent among public sector professionals. In this chapter, a framework is developed that enables these public sector professionals themselves to discuss and reflect on their internal control and accountability processes, and possibly to effect changes in it.
Methodology/approach
The chapter contains a critical analysis of existing research on management control, accountability, and learning in PSOs and describes a reflection and discussion session with a group of senior staff employees at a Dutch university, employing the framework developed in this chapter.
Findings
It is argued that, generally speaking, the “business-like” approach of NPM does not appear appropriate for most public sector activities and may even negatively affect accountability and learning in PSOs.
Social implications
The chapter critically assesses the impact of NPM on PSOs and provides an alternative to NPM in the form of experimentalist governance, with possible positive implications for the effectiveness of public sector activities.
Originality/value
This chapter is among the first to adapt a framework, developed for scientific and descriptive use, for more practical and prescriptive purposes, that is, as an instrument for public sector professionals to discuss and reflect on their internal control and accountability processes.