Giovanni Improta, Giovanni Balato, Carlo Ricciardi, Mario Alessandro Russo, Ida Santalucia, Maria Triassi and Mario Cesarelli
Since healthcare spending accounts for approximately 6.6 per cent of the gross domestic product, reducing waste in health facilities is necessary to generate significant cost…
Abstract
Purpose
Since healthcare spending accounts for approximately 6.6 per cent of the gross domestic product, reducing waste in health facilities is necessary to generate significant cost savings. After previous work concerning the application of Lean Six Sigma (LSS) to hip surgery, the purpose of this paper is to use LSS as the correct methodology to analyse a clinical pathway. Fast track surgery was introduced to the Complex Operative Unit of Orthopaedic and Traumatology of the University Hospital “Federico II” to improve quality and further reduce costs associated with prosthetic hip replacement surgery.
Design/methodology/approach
The DMAIC (Define, measure, analyse, improve, control) roadmap was used as the typical problem-solving approach of the LSS methodology. A rigorous process of defining, measuring, analysing, improving and controlling business problems can be used to reach fixed goals. The paper was written following the Standards for Quality Improvement Reporting Excellence (SQUIRES Guidelines).
Findings
In this work, the authors found that multiple variables could influence the length of hospital stay (LOS) for inpatient treatment, thereby increasing patient management costs due to longer periods of hospitalisation. Therefore, LSS analysis of the implemented corrective actions demonstrated the efficacy and efficiency of the novel protocol. The average LOS was reduced from 10.66 to 7.8 days (−26.8 per cent).
Originality/value
The introduction of fast track surgery was validated through a rigorous LSS analysis, which demonstrated that the new protocol benefitted both patients and the hospital.
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Alessandro Greco, Mario Brandon Russo and Salvatore Gerbino
This paper aims to investigate how the build orientation simultaneously affects the tensile properties, geometrical measurements and surface roughness in material extrusion (MEX…
Abstract
Purpose
This paper aims to investigate how the build orientation simultaneously affects the tensile properties, geometrical measurements and surface roughness in material extrusion (MEX) produced parts.
Design/methodology/approach
An extensive experimental campaign was designed and carried out to elucidate the relationship between the rotation angles (input), defining the part orientation within the build volume, and the (output) variables measured by using 3D models reconstruction, roughness tester and tensile testing machine. Response surface methodology is used to capture the trend of each output relative to the input, while principal component analysis is used to identify relationships among outputs, providing a holistic understanding of how build orientation simultaneously influences mechanical properties, geometrical measurements and surface characteristics.
Findings
The study reveals that build orientation significantly affects nearly all output variables, with a pronounced dependency on the out-of-plane rotation angle. A key finding is the inverse correlation between mechanical strength and both geometrical measurements and surface roughness. This indicates that optimizing build orientation can enhance mechanical strength while minimizing geometrical defects.
Originality/value
This research, a newer addition to the existing literature, contributes to the field of additive manufacturing (AM) by offering an innovative analysis of the interaction between mechanical properties, geometric precision and surface roughness in relation to build orientation. It enhances the understanding of MEX processes and provides valuable insights into optimizing build orientation, thereby improving the competitiveness of AM over traditional production methods.
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Giovanni Improta, Carlo Ricciardi, Anna Borrelli, Alessia D’alessandro, Ciro Verdoliva and Mario Cesarelli
The best treatment for femur fractures is the surgical one within 48 h from the admission to the hospital. These fractures have serious consequences, both in terms of morbidity…
Abstract
Purpose
The best treatment for femur fractures is the surgical one within 48 h from the admission to the hospital. These fractures have serious consequences, both in terms of morbidity and socio-economic impact. In the hospital A.O.R.N. Cardarelli of Naples in Italy, the mean pre-operative length of hospital stay (LOS) was nine days and just 4 per cent of patients was operated within the suggested time. Therefore, a diagnostic-therapeutic-assistance path (DTAP) was implemented to improve the process.
Design/methodology/approach
This paper analyzes two groups of patients (534 and 562, respectively) before and after the introduction of DTAP, through six sigma (SS) based on define, measure, analyze, improve and control cycle. Age, gender, American Society of Anaesthesiologists (ASA) score, cardiovascular diseases, diabetes and allergies were used as independent subgrouping variables. The t-tests and chi-square were performed to compare the groups, tools of SS were used.
Findings
The analyses were conducted considering overall patients and some subgroups. The overall reduction in LOS was about 54 per cent, patients without cardiovascular diseases and with a low ASA score had the highest reduction, more than 60 per cent. All the p-values proved a high statistically significant difference between the two groups.
Research limitations/implications
The influence of the Italian health-care system is a minor limitation while, unfortunately, the lack of a follow-up did not allow quantifying the real gain in health of patients. A lean thinking analysis would suit this context.
Practical implications
There are practical advantages for both hospital and patients: the hospital will have an increase in admissions and more beds available, while patients will benefit of a faster intervention and a shorter wait.
Originality/value
This is the first analysis through SS of DTAP showing its positive influences in terms of both socio-economic impact and patients’ outcome. Policy leaders could use this study as an example to evaluate the introduction of the same clinical pathway in other health facilities.
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Carlo Ricciardi, Giovanni Balato, Maria Romano, Ida Santalucia, Mario Cesarelli and Giovanni Improta
The reduction of costs has a more and more relevant role in the healthcare context, therefore, a large effort is done by health providers to this aim, for example, by reducing the…
Abstract
Purpose
The reduction of costs has a more and more relevant role in the healthcare context, therefore, a large effort is done by health providers to this aim, for example, by reducing the length of hospital stay (LOS) of patients undergoing surgery. Fast track surgery fits perfectly this issue and was applied to patients undergoing knee replacement surgery due to Osteoarthritis, one of the most common diseases of aged population. The paper aims to discuss these issues.
Design/methodology/approach
Lean six sigma was applied to analyze the implementation of fast track surgery through the define, measure, analyze, improve, control roadmap, used as a typical problem-solving approach. It is characterized by five operational phases, which make possible the achievement of fixed goals through a rigorous process of defining, measuring, analyzing, improving and controlling business problems.
Findings
The corrective action, consisting in the application of fast track surgery, improved both effectiveness and efficiency of the process of care. The average length of hospital stay (LOS) was reduced from 8.34 to 6.68 days (–19.9 percent) and its standard deviation from 2.41 to 1.99 days (–17.1 percent). The statistical significance of this decrease was verified by means of proper tests. Moreover, some variables influencing the LOS were identified.
Research limitations/implications
The follow up and the satisfaction of patients were not analyzed and could be a future development of this study.
Practical implications
Patients will experience a faster recovery while the hospital will benefit from a rise of available beds. The effect is a general improvement of hospital management.
Originality/value
The introduction of fast track surgery for patients undergoing knee replacement surgery made significantly reduce LOS and, consequently, costs’ with a money saving of more than 50,000 euro per year.
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Examines the fifthteenth published year of the ITCRR. Runs the whole gamut of textile innovation, research and testing, some of which investigates hitherto untouched aspects…
Abstract
Examines the fifthteenth published year of the ITCRR. Runs the whole gamut of textile innovation, research and testing, some of which investigates hitherto untouched aspects. Subjects discussed include cotton fabric processing, asbestos substitutes, textile adjuncts to cardiovascular surgery, wet textile processes, hand evaluation, nanotechnology, thermoplastic composites, robotic ironing, protective clothing (agricultural and industrial), ecological aspects of fibre properties – to name but a few! There would appear to be no limit to the future potential for textile applications.
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Examines the thirteenth published year of the ITCRR. Runs the whole gamut of textile innovation, research and testing, some of which investigates hitherto untouched aspects…
Abstract
Examines the thirteenth published year of the ITCRR. Runs the whole gamut of textile innovation, research and testing, some of which investigates hitherto untouched aspects. Subjects discussed include cotton fabric processing, asbestos substitutes, textile adjuncts to cardiovascular surgery, wet textile processes, hand evaluation, nanotechnology, thermoplastic composites, robotic ironing, protective clothing (agricultural and industrial), ecological aspects of fibre properties – to name but a few! There would appear to be no limit to the future potential for textile applications.
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Examines the fourteenth published year of the ITCRR. Runs the whole gamut of textile innovation, research and testing, some of which investigates hitherto untouched aspects…
Abstract
Examines the fourteenth published year of the ITCRR. Runs the whole gamut of textile innovation, research and testing, some of which investigates hitherto untouched aspects. Subjects discussed include cotton fabric processing, asbestos substitutes, textile adjuncts to cardiovascular surgery, wet textile processes, hand evaluation, nanotechnology, thermoplastic composites, robotic ironing, protective clothing (agricultural and industrial), ecological aspects of fibre properties – to name but a few! There would appear to be no limit to the future potential for textile applications.
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Examines the fifteenth published year of the ITCRR. Runs the whole gamut of textile innovation, research and testing, some of which investigates hitherto untouched aspects…
Abstract
Examines the fifteenth published year of the ITCRR. Runs the whole gamut of textile innovation, research and testing, some of which investigates hitherto untouched aspects. Subjects discussed include cotton fabric processing, asbestos substitutes, textile adjuncts to cardiovascular surgery, wet textile processes, hand evaluation, nanotechnology, thermoplastic composites, robotic ironing, protective clothing (agricultural and industrial), ecological aspects of fibre properties – to name but a few! There would appear to be no limit to the future potential for textile applications.
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Claudio Rocco, Gianvito Mitrano, Angelo Corallo, Pierpaolo Pontrandolfo and Davide Guerri
The future increase of chronic diseases in the world requires new challenges in the health domain to improve patients' care from the point of view of the organizational processes…
Abstract
Purpose
The future increase of chronic diseases in the world requires new challenges in the health domain to improve patients' care from the point of view of the organizational processes, clinical pathways and technological solutions of digital health. For this reason, the present paper aims to focus on the study and application of well-known clinical practices and efficient organizational approaches through an innovative model (TALIsMAn) to support new care process redesign and digitalization for chronic patients.
Design/methodology/approach
In addition to specific clinical models employed to manage chronic conditions such as the Population Health Management and Chronic Care Model, we introduce a Business Process Management methodology implementation supported by a set of e-health technologies, in order to manage Care Pathways (CPs) digitalization and procedures improvement.
Findings
This study shows that telemedicine services with advanced devices and technologies are not enough to provide significant changes in the healthcare sector if other key aspects such as health processes, organizational systems, interactions between actors and responsibilities are not considered and improved. Therefore, new clinical models and organizational approaches are necessary together with a deep technological change, otherwise, theoretical benefits given by telemedicine services, which often employ advanced Information and Communication Technology (ICT) systems and devices, may not be translated into effective enhancements. They are obtained not only through the implementation of single telemedicine services, but integrating them in a wider digital ecosystem, where clinicians are supported in different clinical steps they have to perform.
Originality/value
The present work defines a novel methodological framework based on organizational, clinical and technological innovation, in order to redesign the territorial care for people with chronic diseases. This innovative ecosystem applied in the Italian research project TALIsMAn is based on the concept of a continuum of care and digitalization of CPs supported by Business Process Management System and telemedicine services. The main goal is to organize the different socio-medical activities in a unique and integrated IT system that should be sustainable, scalable and replicable.
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Antonella Fiorillo, Alfonso Sorrentino, Arianna Scala, Vincenzo Abbate and Giovanni Dell'aversana Orabona
The 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…
Abstract
Purpose
The 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/approach
The 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.
Findings
The 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/value
The 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.