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

Effectiveness and Best Practices of Lean and Six Sigma Methodologies in Hospitals

Healthcare quality and costs are a growing problem in the United States. Healthcare organizations are facing increasing costs combined with declining quality (Schoenbaum). This unsustainable trend is putting a great burden on the health care system as a whole. The improvement of quality within the healthcare system would increase the value of the care (Schoenbaum).Improving healthcare quality, and thereby lowering the costs, is critical for the sustainability of healthcare organizations. There are many different ways that organizations can use quality to reduce costs and increase the quality of service to their patients. There are also various ways an organization can implement quality. The processes can lead to different results and focuses. The potential processes include lean based A3 Report, Kaizen events, and Six Sigma. These processes focus on continuous improvement of quality within a process. The ideal situation would utilize these processes to create a high quality environment while lowering costs. This report will investigate the impact of projects utilizing the A3, Kaizen, and Six Sigmamethodologies in order to improve processes efficiency,increase quality, and reduce costs of care.These methods can be applied in many different organizations, including the health care industry. The impact of these process improvement projects should be substantial and essential to the health care industry. The impact of the methodologies will be analyzed to see if they substantially reduce the costs and increase the quality. The focus of this research is on hospitals and will compare hospitals in a quality position, as defined by the 100 Top hospitals list and the MalcolmBaldrigeQuality Award recipients nationwide, and other regional hospitals in the Northeast not currently on the 100 Top lists or a Baldrige award winner. The goal of any organization should be to increase the quality of their service. An ACPE Quality of Care Surveyfound that 18.5% of respondents utilized Six Sigma to improve quality, 13.3% utilized Lean processes, 12.2% used vendor-provided systems, 26.7% used other methods including homegrown, and 29.2% did not utilize any programs (Martin). This project looks to identify if there are trends between those that utilize the programs and positioning as a top quality performance hospital and if so what quality management programs had the biggest impact at the different types of hospitals. While this project focused on hospitals as the health care organization to be surveyed and examined, similar principals would be expected to hold true for any patient facing organization

An experience of introducing last planner into a UK construction project

The Last Planner methodology developed by the Lean Construction Institute is a production control tool which has possible benefits for improving planning in the UK construction industry. Its application has been considered in countries outside the UK but there is scope for considering whether it is a practical tool for use in UK construction projects. The application of the methodology to a UK construction project was studied with a view to establishing the value of the tool and the possible barriers to its implementation. After training by the writers the method was developed for use on a project by the project team and applied to the main activities. The writers observed the process and interviewed the participants. The methodology had some success in terms of improving structure and discipline in planning but there were structural and cultural barriers identified which need to be addressed before it can be fully successful

Supply chain uncertainty:a review and theoretical foundation for future research

Supply-chain uncertainty is an issue with which every practising manager wrestles, deriving from the increasing complexity of global supply networks. Taking a broad view of supply-chain uncertainty (incorporating supply-chain risk), this paper seeks to review the literature in this area and develop a theoretical foundation for future research. The literature review identifies a comprehensive list of 14 sources of uncertainty, including those that have received much research attention, such as the bullwhip effect, and those more recently described, such as parallel interaction. Approaches to managing these sources of uncertainty are classified into: 10 approaches that seek to reduce uncertainty at its source; and, 11 approaches that seek to cope with it, thereby minimising its impact on performance. Manufacturing strategy theory, including the concepts of alignment and contingency, is then used to develop a model of supply-chain uncertainty, which is populated using the literature review to show alignment between uncertainty sources and management strategies. Future research proposed includes more empirical research in order to further investigate: which uncertainties occur in particular industrial contexts; the impact of appropriate sources/management strategy alignment on performance; and the complex interplay between management strategies and multiple sources of uncertainty (positive or negative)

Possibilities and limitations of protein supply in organic poultry and pig production

It is one of the general recommendations in animal nutrition that the diet should be formulated according to the specific requirements of animals at the various stages of their development. To which degree the farmer can adapt the nutrient supply to the specific requirements of the animals depends primarily on the production goal and on the availability of nutrient resources. This report gives a general introduction to the present situation for dietary protein supply to poultry and pig production in relation to the principles for organic agriculture and husbandry production. Furthermore it includes partly literature based on research from conventional animal production, as the requirements on the level of the animals are not different in both systems. Moreover, there only few research projects of organic production systems available. This report is primarily focussing on the question whether a nutrient supply of 100% organic feed can and should be realised. In this context, it is not possible to cover all aspects in detail as the report cannot replace a textbook. The main emphasis is laid on a coherent argumentation based on the leading ideas of organic agriculture. Concerning further relevant aspects it is referred to the report ”Supply and demand for concentrated organic feed in the EU in 2002 and 2003” by Susanne Padel as part of the same EU-project: ‘Research to support the EU-regulation on Organic Agriculture’ (www.organic-revision.org) and to the project “Availability of organically reared livestock” (S. Gomez, JRC, Institute for Prospective Technological Studies, this study is expected to be completed in November 2005). In conventional animal production, a nutrient supply that is closely related to the requirements is an important tool in the performance-oriented production (FLACHOWSKY, 1998). The objective of animal nutrition is to adapt the nutrient supply as accurately as possible to the requirements resulting from maintenance and performance need. Soybean meal, due to the high protein content and high protein quality, has developed into the most important protein source in the nutrition of monogastric animals. Additionally, synthetic amino acids (DL-methionine) and industrial amino acids (produced from microbial fermentation, L-amino acids) are used to balance the supply of essential amino acids. While the use of soybean meal and synthetic amino acids is normal practice in conventional animal production, the Council-Regulation No. 2092/91, amended by Council Regulation No. 1804/99 on organic livestock production bans the use of chemically extracted soybean meal and synthetic amino acids on organic farms as livestock must be fed primarily on organically produced feedstuffs (Annex 1, paragraph 4.2). By way of a derogation from paragraph 4.2, for a transitional period expiring on 24 August 2005, the use of a limited proportion of non-organic feedstuffs is authorised where farmers can show to the satisfaction of the inspection body that they are unable to obtain feed exclusively from organic production (paragraph 4.8). The derogation, although with a declining percentage of non-organic feedstuffs over the next years, has been prolonged in July 2005. The preferable use of home-grown feedstuffs and limitations in the choice of boughtin feedstuffs can be the cause of considerable variation in the composition of the diets, and considerably restrict the possibilities for the adaptation of the feed ration to the specific requirements. Due to the limited availability of essential amino acids in particular, there is concern that nutritional imbalances encountered in practice might lead to deteriorating animal health and welfare. On the other hand, there is also the concern that allowing conventional feedstuffs to be fed in organic livestock production will result in intensification of production. The intensification might cause the same problems in organic production as conventional production already shows (animal health problems, risk of residues and GM contamination etc.). Thus, the use of non-organic feedstuffs may have a damaging effect on consumer confidence in organic products of animal origin. In the following the nutritional-physiological effects of a variation in protein supply with respect to growth performance and protein accretion in broilers, turkeys, laying hens, and pigs are examined by means of a literature review. Additionally, the potential effects of the protein content in the diet on product quality, animal health and environmental damage are addressed. It is the aim of the report to provide an overview of the many different aspects of the protein supply in organic poultry and pig production. Many different aspects are taken into account to elaborate possibilities to handle the use of organic and non-organic feedstuffs with respect to the objectives and framework conditions of organic livestock production. However, due to the complex interactions not all aspects can be covered. There is room and need for explanation and for further research

The application of a pilot pull planning system to construction projects

A new planning system was introduced as a pilot within a large UK construction company. The system, which attempts to address some of the problems of construction “front end” planning, is investigated relative to Lean Construction and specifically the Last Planner system. The purpose is to see if it can be used as the basis for applying a lean planning model which the company intends to introduce and test through a research project. The existing system is seen to have strengths in terms of goodwill and commitment from the participants but is still fundamentally linked to the schedule pushed traditional approach to planning which is seen to be unsuccessful. An attempt to use “first run studies” to produce high quality planning and performance information was partly successful and indicated possibilities for future implementation. Further work is needed to fully develop the application model and training in the fundamentals of the system will be needed to improve performance

Optimal management of sarcopenia

Sarcopenia is the progressive generalized loss of skeletal muscle mass, strength, and function which occurs as a consequence of aging. With a growing older population, there has been great interest in developing approaches to counteract the effects of sarcopenia, and thereby reduce the age-related decline and disability. This paper reviews (1) the mechanisms of sarcopenia, (2) the diagnosis of sarcopenia, and (3) the potential interventions for sarcopenia. Multiple factors appear to be involved in the development of sarcopenia including the loss of muscle mass and muscle fibers, increased inflammation, altered hormonal levels, poor nutritional status, and altered renin–angiotensin system. The lack of diagnostic criteria to identify patients with sarcopenia hinders potential management options. To date, pharmacological interventions have shown limited efficacy in counteracting the effects of sarcopenia. Recent evidence has shown benefits with angiotensin-converting enzyme inhibitors; however, further randomized controlled trials are required. Resistance training remains the most effective intervention for sarcopenia; however, older people maybe unable or unwilling to embark on strenuous exercise training programs

Vertical separation of the energy-distribution industry; an assessment of several options for unbundling

The Dutch Minister of Economic Affairs has proposed to replace the currently implemented structure of legal unbundling of the energy distribution industry by ownership unbundling. In this study we analyse the costs and benefits of this proposal. We compare the proposal�to the current situation and to two alternative options that strengthen legal unbundling. We identify four mutually-related categories of benefits: better performance of networks, more efficient regulation, improved effectiveness of competition, and benefits of privatisation; and three categories of costs: one-off transaction costs, loss of economies of scope and the risk of less investment in generation. The analysis highlights that the benefits depend on the future development in small-scale generation and on allocation of the management of transmission networks. Mainly because of the uncertainty about the future role of small-scale generation and the uncertainty about the magnitude of the one-off transaction costs related to cross-border leases, the net welfare effect of ownership unbundling at the distribution level is ambiguous. We identify an alternative route for achieving some of the benefits considered.

High performance workplaces and skill development: Updating the map of the territory

The impact of High Performance Workplace Systems (HPWS) on workers and unions is a contentious area for debate in the fields of industrial relations and social science in general. Proponents of HPWS claim that one of the benefits for workers is that they enable workers to develop and raise their skill levels. This paper offers a preliminary evaluation of that claim by sketching an updated map of the territory. It concludes that the HPWS literature contains significant weaknesses concerning the definition of skill in explaining what skill development means for workers, individually and collectively