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Article
Publication date: 13 March 2017

Pascale Simons, Huub Backes, Jochen Bergs, Davy Emans, Madelon Johannesma, Maria Jacobs, Wim Marneffe and Dominique Vandijck

Treatment delays must be avoided, especially in oncology, to assure sustainable high-quality health care and increase the odds of survival. The purpose of this paper is to…

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Abstract

Purpose

Treatment delays must be avoided, especially in oncology, to assure sustainable high-quality health care and increase the odds of survival. The purpose of this paper is to hypothesize that waiting times would decrease and patients and employees would benefit, when specific lean interventions are incorporated in an organizational improvement approach.

Design/methodology/approach

In 2013, 15 lean interventions were initiated to improve flow in a single radiotherapy institute. Process/waiting times, patient satisfaction, safety, employee satisfaction, and absenteeism were evaluated using a mixed methods methodology (2010-2014). Data from databases, surveys, and interviews were analyzed by time series analysis, χ2, multi-level regression, and t-tests.

Findings

Median waiting/process times improved from 20.2 days in 2012 to 16.3 days in 2014 (p<0.001). The percentage of palliative patients for which waiting times had exceeded Dutch national norms (ten days) improved from 35 (six months in 2012: pre-intervention) to 16 percent (six months in 2013-2014: post-intervention; p<0.01), and the percentage exceeding national objectives (seven days) from 22 to 17 percent (p=0.44). For curative patients, exceeding of norms (28 days) improved from 17 (2012) to 8 percent (2013-2014: p=0.05), and for the objectives (21 days) from 18 to 10 percent (p<0.01). Reported safety incidents decreased 47 percent from 2009 to 2014, whereas safety culture, awareness, and intention to solve problems improved. Employee satisfaction improved slightly, and absenteeism decreased from 4.6 (2010) to 2.7 percent (2014; p<0.001).

Originality/value

Combining specific lean interventions with an organizational improvement approach improved waiting times, patient safety, employee satisfaction, and absenteeism on the short term. Continuing evaluation of effects should study the improvements sustainability.

Details

International Journal of Health Care Quality Assurance, vol. 30 no. 2
Type: Research Article
ISSN: 0952-6862

Keywords

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Article
Publication date: 9 February 2015

Pascale A.M. Simons, Jos Benders, Wim Marneffe, Madelon Pijls-Johannesma and Dominique Vandijck

For change programs to succeed, it is vital to have a detailed understanding of employees’ views regarding the program, especially when the proposed changes are potentially…

626

Abstract

Purpose

For change programs to succeed, it is vital to have a detailed understanding of employees’ views regarding the program, especially when the proposed changes are potentially contested. Gaining insight into employee perceptions helps managers to decide how to proceed. The authors conducted two workshops in a radiotherapy institute to assess the benefits and drawbacks, as well as their underlying causes, of a proposed Lean change program. Managers’ views on the workshops’ usefulness were charted. The paper aims to discuss these issues.

Design/methodology/approach

Two workshops were organized in which employees predicted positive and negative effects of a Lean program. The workshops combined a structured brainstorm (KJ-technique) and an evaluation of the expected effects. Eight top managers judged the workshops’ value on supporting decision making.

Findings

In total, 15 employees participated in the workshops. Participants from workshop 2 reported more expected effects (27 effects; 18 positive) than from workshop 1 (14 effects; six positive). However, when effects were categorized, similar results were shown. Three from eight managers scored the results relevant for decision making and four neutral. Seven managers recommended future use of the instrument. Increased employee involvement and bottom-up thinking combined with relatively low costs were appreciated most.

Practical implications

The workshop could serve as a simple instrument to improve decision making and enhance successful implementation of change programs, as it was expected to enhance employees’ involvement and was relatively easy to conduct and cheap.

Originality/value

The workshop increased insight into employee views, facilitating adaptive actions by healthcare organization managers.

Details

International Journal of Health Care Quality Assurance, vol. 28 no. 1
Type: Research Article
ISSN: 0952-6862

Keywords

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Article
Publication date: 13 June 2016

Pascale Simons, Jos Benders, Jochen Bergs, Wim Marneffe and Dominique Vandijck

Sustainable improvement is likely to be hampered by ambiguous objectives and uncertain cause-effect relations in care processes (the organization’s decision-making context). Lean…

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Abstract

Purpose

Sustainable improvement is likely to be hampered by ambiguous objectives and uncertain cause-effect relations in care processes (the organization’s decision-making context). Lean management can improve implementation results because it decreases ambiguity and uncertainties. But does it succeed? Many quality improvement (QI) initiatives are appropriate improvement strategies in organizational contexts characterized by low ambiguity and uncertainty. However, most care settings do not fit this context. The purpose of this paper is to investigate whether a Lean-inspired change program changed the organization’s decision-making context, making it more amenable for QI initiatives.

Design/methodology/approach

In 2014, 12 professionals from a Dutch radiotherapy institute were interviewed regarding their perceptions of a Lean program in their organization and the perceived ambiguous objectives and uncertain cause-effect relations in their clinical processes. A survey (25 questions), addressing the same concepts, was conducted among the interviewees in 2011 and 2014. The structured interviews were analyzed using a deductive approach. Quantitative data were analyzed using appropriate statistics.

Findings

Interviewees experienced improved shared visions and the number of uncertain cause-effect relations decreased. Overall, more positive (99) than negative Lean effects (18) were expressed. The surveys revealed enhanced process predictability and standardization, and improved shared visions.

Practical implications

Lean implementation has shown to lead to greater transparency and increased shared visions.

Originality/value

Lean management decreased ambiguous objectives and reduced uncertainties in clinical process cause-effect relations. Therefore, decision making benefitted from Lean increasing QI’s sustainability.

Details

International Journal of Health Care Quality Assurance, vol. 29 no. 5
Type: Research Article
ISSN: 0952-6862

Keywords

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