What cases on lean hospital transformation tell us?

The scientific knowledge about the lean transformation of hospital processes is at best in its “emerging” phase; neither related international, nor Hungarian literature offers a systematic, comprehensive description of the phenomenon (Brandao de Souza, 2009). In this paper empirical evidences concerning the lean transformation of hospital processes are researched and systemized. Thus it provides a new insight of existing knowledge in order to provide solid base for further researches and practical actions

Repeatability of brown adipose tissue measurements on FDG PET/CT following a simple cooling procedure for BAT activation

Brown Adipose Tissue (BAT) is present in a significant number of adult humans and can be activated by exposure to cold. Measurement of active BAT presence, activity, and volume are desirable for determining the efficacy of potential treatments intended to activate BAT. The repeatability of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) measurements of BAT presence, activity, and volume under controlled conditions has not been extensively studied. Eleven female volunteers underwent double baseline FDG PET imaging performed following a simple, regional cold intervention intended to activate brown fat. The cold intervention involved the lightly-clothed participants intermittently placing their feet on a block of ice while sitting in a cooled room. A repeat study was performed under the same conditions within a target of two weeks. FDG scans were obtained and maximum standardized uptake value adjusted for lean body mass (SULmax), CT Hounsfield units (HU), BAT metabolic volume (BMV), and total BAT glycolysis (TBG) were determined according to the Brown Adipose Reporting Criteria in Imaging STudies (BARCIST) 1.0. A Lin's concordance correlation (CCC) of 0.80 was found for BMV between test and retest imaging. Intersession BAT SULmax was significantly correlated (r = 0.54; p < 0.05). The session #1 mean SULmax of 4.92 ± 4.49 g/mL was not significantly different from that of session #2 with a mean SULmax of 7.19 ± 7.34 g/mL (p = 0.16). BAT SULmax was highly correlated with BMV in test and retest studies (r ≥ 0.96, p < 0.001). Using a simplified ice-block cooling method, BAT was activated in the majority (9/11) of a group of young, lean female participants. Quantitative assessments of BAT SUL and BMV were not substantially different between test and retest imaging, but individual BMV could vary considerably. Intrasession BMV and SULmax were strongly correlated. The variability in estimates of BAT activity and volume on test-retest with FDG should inform sample size choice in studies quantifying BAT physiology and support the dynamic metabolic characteristics of this tissue. A more sophisticated cooling method potentially may reduce variations in test-retest BAT studies

Quantifying the improvement of surrogate indices of hepatic insulin resistance using complex measurement techniques

We evaluated the ability of simple and complex surrogate-indices to identify individuals from an overweight/obese cohort with hepatic insulin-resistance (HEP-IR). Five indices, one previously defined and four newly generated through step-wise linear regression, were created against a single-cohort sample of 77 extensively characterised participants with the metabolic syndrome (age 55.6±1.0 years, BMI 31.5±0.4 kg/m2; 30 males). HEP-IR was defined by measuring endogenous-glucose-production (EGP) with [6–62H2] glucose during fasting and euglycemic-hyperinsulinemic clamps and expressed as EGP*fasting plasma insulin. Complex measures were incorporated into the model, including various non-standard biomarkers and the measurement of body-fat distribution and liver-fat, to further improve the predictive capability of the index. Validation was performed against a data set of the same subjects after an isoenergetic dietary intervention (4 arms, diets varying in protein and fiber content versus control). All five indices produced comparable prediction of HEP-IR, explaining 39–56% of the variance, depending on regression variable combination. The validation of the regression equations showed little variation between the different proposed indices (r2 = 27–32%) on a matched dataset. New complex indices encompassing advanced measurement techniques offered an improved correlation (r = 0.75, P<0.001). However, when validated against the alternative dataset all indices performed comparably with the standard homeostasis model assessment for insulin resistance (HOMA-IR) (r = 0.54, P<0.001). Thus, simple estimates of HEP-IR performed comparable to more complex indices and could be an efficient and cost effective approach in large epidemiological investigations

Hybrid method to assist business process reengineering in developing countries

Public institution spending in developing countries is constantly increasing in the last decades, and the available data shows that there is a lack of efficiency in resource consumption not reflected in efficiency improvement. This necessitates the need to reengineer business process that will increase efficiency at a lower cost. To address this, the researcher employed interview and observation data collection strategy where 50 employees from the central registration team of Yobe State University and 22 Health practitioners including doctors, nurses and radiologists from Sani Abatcha Specialist Hospital, Damaturu-Nigeria were interviewed and observed respectively. In this research, the approach based on design science that integrates Knowledge Map, Enterprise Ontology and lean using approach to find unnecessary transactions that must be reengineered to improve the organizational efficiency was adopted. This approach was chosen as a basis for finding a solution because it provides a better understanding of the dynamics of an organization, and allows a good alignment between the enterprise design and operation. Demonstrations of the processes collected from Yobe State University and Radiology Department of Sani Abatcha Specialist Hospital, Damaturu-Nigeria, making it possible to find transactions that can be refined or improved. Evaluation was carried out by means of descriptions and the Four Principles from Österle. Findings indicated that the number of transactions were reduced by 25% in the case of Yobe State University registration process and also reduced by 41.7% in the case of Radiology Department of Sani Abatcha Specialist Hospital. In conclusion, the results proved that the approach yields an adequate and clear process view and is reliable when it comes to reengineering organizational operational processes

Focal Spot, Spring 2005

https://digitalcommons.wustl.edu/focal_spot_archives/1099/thumbnail.jp

Improving the Supply Process in an Interventional Procedures Unit

In the combined cardiac catheterization and interventional radiology unit of an urban Midwestern hospital, having supplies when and where they are needed is necessary for efficiently and safely completing a wide variety of procedures. Due to the complexity of the supply chain process in this setting, baseline data collection revealed many missing supplies, overnight shipments, and expired items. In this project, the MSN student sought to determine whether a Clinical Nurse Leader driven Lean Six Sigma based approach to supply chain interventions in the interventional procedures setting would improve outcomes and lead to financial savings by decreasing waste and variation. The DMAIC model was used as a framework for the project and a three phase Kaizen improvement project was developed with the final stage being implementation of a two-bin (kanban) supply storage and ordering system. This paper will provide an introduction to the clinical microsytem, a literature review of evidence regarding the proposed intervention, a description of the DMAIC framework, an outline of the clinical protocol, and a final evaluation of its implementation. While installation of the two-bin system is currently awaiting funding approval, analysis of changes made in preparation thus far include a decrease in the number of items missing each morning, a decrease in number of overnight shipments, and a decrease in expired items. Significant financial savings have also been achieved, which will be discussed. Moving forward, Lean Six Sigma is a promising approach to attaining further sustainable improvements in the supply process. The Clinical Nurse Leader is in an optimal position to combine knowledge of healthcare processes and team management skills to continue implementation of the proposed intervention

Scott & White Healthcare: Opening Up and Embracing Change to Improve Performance

Offers a case study of a multispeciality system with the attributes of an ideal healthcare delivery system as defined by the Fund. Describes a culture of continuous improvement, collaboration and peer accountability, and a comprehensive approach to care

Outlook Magazine, Spring 2014

https://digitalcommons.wustl.edu/outlook/1192/thumbnail.jp