Analysis of Delays in Processing Times in an Ophthalmology Clinic

Efficiency is an important component of any medical practice. It facilitates quality care, reduction in wait time, patient and staff satisfaction, and decreased cost. The purpose of this study was to identify bottlenecks in the current processing system in the Eye Center at Hershey Penn State Medical Center. Data was obtained about patients arriving at the clinic for ancillary tests such as visual field testing and retinal imaging. Analysis of this data revealed a statistically significant longer average length of visit for patients who received testing in comparison to those who did not. However, due to the small sample size of this study, we were unable to conclude that patients who received testing had longer wait times between segments. Further work in this field will need to be conducted to examine processes in the clinic in greater detail to identify those in need of improvement and guide future implementation of Lean strategies

Agile six sigma in healthcare: Case study at santobono pediatric hospital

Healthcare is one of the most complex systems to manage. In recent years, the control of processes and the modelling of public administrations have been considered some of the main areas of interest in management. In particular, one of the most problematic issues is the management of waiting lists and the consequent absenteeism of patients. Patient no-shows imply a loss of time and resources, and in this paper, the strategy of overbooking is analysed as a solution. Here, a real waiting list process is simulated with discrete event simulation (DES) software, and the activities performed by hospital staff are reproduced. The methodology employed combines agile manufacturing and Six Sigma, focusing on a paediatric public hospital pavilion. Different scenarios show that the overbooking strategy is effective in ensuring fairness of access to services. Indeed, all patients respect the times dictated by the waiting list, without “favouritism”, which is guaranteed by the logic of replacement. In a comparison between a real sample of bookings and a simulated sample designed to improve no-shows, no statistically significant difference is found. This model will allow health managers to provide patients with faster service and to better manage their resources. © 2020 by the authors. Licensee MDPI, Basel, Switzerland

A survey of health care models that encompass multiple departments

In this survey we review quantitative health care models to illustrate the extent to which they encompass multiple hospital departments. The paper provides general overviews of the relationships that exists between major hospital departments and describes how these relationships are accounted for by researchers. We find the atomistic view of hospitals often taken by researchers is partially due to the ambiguity of patient care trajectories. To this end clinical pathways literature is reviewed to illustrate its potential for clarifying patient flows and for providing a holistic hospital perspective

Understanding the UK hospital supply chain in an era of patient choice

Author Posting © Westburn Publishers Ltd, 2011. This is a post-peer-review, pre-copy-edit version of an article which has been published in its definitive form in the Journal of Marketing Management, and has been posted by permission of Westburn Publishers Ltd for personal use, not for redistribution. The article was published in Journal of Marketing Management, 27(3-4), 401 - 423, doi:10.1080/0267257X.2011.547084 http://dx.doi.org/10.1080/0267257X.2011.547084The purpose of this paper is to investigate the UK hospital supply chain in light of recent government policy reform where patients will have, inter alia, greater choice of hospital for elective surgery. Subsequently, the hospital system should become far more competitive with supply chains having to react to these changes as patient demand becomes less predictable. Using a qualitative case study methodology, hospital managers are interviewed on a range of issues. Views on the development of the hospital supply chain in different phases are derived, and are used to develop a map of the current hospital chain. The findings show hospital managers anticipating some significant changes to the hospital supply chain and its workings as Patient Choice expands. The research also maps the various aspects of the hospital supply chain as it moves through different operational phases and highlights underlying challenges and complexities. The hospital supply chain, as discussed and mapped in this research, is original work given there are no examples in the literature that provide holistic representations of hospital activity. At the end, specific recommendations are provided that will be of interest to service to managers, researchers, and policymakers

Revisão Sistemática da Literatura sobre o Impacto da Aplicação da Filosofia Lean na Consulta Externa Hospitalar

A importância de analisar os processos para poder proporcionar melhores cuidados de saúde e a melhor experiência aos utentes, sem esquecer os profissionais, tem vindo a ser enfatizada e assumida como de grande importância por parte das administrações das unidades de saúde. A Consulta Externa é, nesse sentido, um dos serviços hospitalares onde a perceção do utente, para aquilo que entende agregar valor, é mais notória. Aqui, o fluxo de pessoas é maior e, por conseguinte, é necessário que os processos estejam todos alinhados, a fim de permitir que se desenvolvam sem estrangulamentos, entregando assim valor para o utente. Nesse sentido a filosofia Lean e o seu conceito de identificar e eliminar desperdícios e caminhar sempre para a melhoria contínua, constituem-se como uma mais-valia. A acrescer a este facto, o Lean Thinking e os seus princípios, bem como as ferramentas e metodologias que lhe estão associadas, já deram provas da sua aplicabilidade e utilidade para a área da saúde. O presente estudo teve por objetivo avaliar o impacto da aplicação da filosofia Lean na Consulta Externa, através da revisão sistemática da literatura. Para isso, procedeu-se à análise, após pesquisa e seleção de acordo com critérios previamente definidos, de vinte e um artigos, referentes aquele serviço em unidades hospitalares. Foram analisadas a efetiva utilização de ferramentas, metodologias e princípios Lean e o seu real impacto para os utentes, não esquecendo os profissionais, nomeadamente ao nível da satisfação, reclamações ou tempos de espera. O estudo concluiu que com a aplicação da filosofia Lean na Consulta Externa dessas unidades hospitalares, especialmente ferramentas como o mapeamento dos processos ou princípios como valor e cadeia de valor, o impacto foi positivo, materializando-se, em benefícios conseguidos como o aumento da satisfação dos utentes, eliminação de etapas que não acrescentavam valor, melhoria da gestão visual e redução dos tempos de espera. Para trabalhos futuros, sugere-se uma linha de investigação relacionada com este tema, mas que associe a metodologia Lean e os seus princípios, com o conceito da área de gestão de projetos, Lean Agile, implementados na Consulta Externa de alguns hospitais públicos portugueses.The importance of analyzing processes in order to provide better health care and the best experience for users, without forgetting professionals, has been emphasized and assumed as of great importance by the administrations of health units. The External Consultation is, in this sense, one of the hospital services where the user's perception of what he or she intends to add value is most notorious. Here, the flow of people is greater and, therefore, it is necessary that the processes are all aligned, in order to allow them to develop without bottlenecks, thus delivering value to the user. In this sense, the Lean philosophy and its concept of identifying and eliminating waste and always moving towards continuous improvement, constitute an added value. In addition to this fact, Lean Thinking and its principles, as well as the tools and methodologies associated with it, have already proven their applicability and usefulness in the health area. This study aimed to evaluate the impact of applying the Lean philosophy in External Consultation, through a systematic review of the literature. For this, we proceeded to the analysis, after research and selection according to previously defined criteria, of twenty-one articles, referring to that service in hospital units. The effective use of Lean tools, methodologies and principles and their real impact on users were analysed, not forgetting professionals, namely in terms of satisfaction, complaints or waiting times. The study concluded that with the application of the Lean philosophy in the External Consultation of these hospital units, especially tools such as the mapping of processes or principles such as value and value chain, the impact was positive, materializing in benefits achieved such as increased satisfaction of users, elimination of steps that did not add value, improvement of visual management and reduction of waiting times. For future work, a line of research related to this topic is suggested, but which associates the Lean methodology and its principles, with the concept of the project management area, Lean Agile, implemented in the External Consultation of Portuguese public hospitals

Modelling based framework for the management of emergency departments.

In the twenty-first century, the healthcare industry faces ever-changing economic, social, political and technology challenges. Costs are rising, funding is diminishing, human and fiscal resources are becoming scarcer, customer-expectations are rising, the complexity of disease is increasing and technology is becoming more complex. These trends have a massive impact on every aspect of hospital operations and the Emergency Department is no exception. Overcrowding in the Emergency Department (ED) in hospitals has become a growing problem in many developed countries around the world. ED overcrowding has a direct effect on patient-care, including compromised patient-safety, increased length-of-stay, increased mortality and morbidity-rates and increased costs. Healthcare policy-makers and hospital and ED administrators are being forced to search for ways to improve the capacity of EDs by better utilisation of existing resources and creating more efficient systems to overcome this problem.Throughout the past few decades, there has been an increasing trend of using numerous systems-analysis tools and techniques which have come from manufacturing and other service industries to address the various issues in healthcare and EDs. Among those tools Discrete-Event Simulation (DES) is a powerful tool to improve the efficiency and capacity in dynamic and complex systems. Use of these tools to address the overcrowding problem in EDs has been patchy; specific aspects of issues have been studied but no attempt has been made to deploy DES or any other systems-analysis tool in a strategic and holistic manner.The aim of this research is to develop a modelling-based framework to manage the overcrowding problem in EDs. The research identified the causes of overcrowding in EDs and developed a decisions-framework with the long-term, medium-term and short-tem decisions in EDs that related to the overcrowding problem. Finally, it identified the best possible systems-analysis tools to support those decisions to overcome the overcrowding problem in EDs. This research could help the healthcare policy-makers, managers, systems-engineers as well as the researchers and consultants who are interesting in the Emergency Department operational management

Effects of lean interventions supported by digital technologies on healthcare services: a systematic review

Despite the increasing utilization of lean practices and digital technologies (DTs) related to Industry 4.0, the impact of such dual interventions on healthcare services remains unclear. This study aims to assess the effects of those interventions and provide a comprehensive understanding of their dynamics in healthcare settings. The methodology comprised a systematic review following the PRISMA guidelines, searching for lean interventions supported by DTs. Previous studies reporting outcomes related to patient health, patient flow, quality of care, and efficiency were included. Results show that most of the improvement interventions relied on lean methodology followed by lean combined with Six Sigma. The main supporting technologies were simulation and automation, while emergency departments and laboratories were the main settings. Most interventions focus on patient flow outcomes, reporting positive effects on outcomes related to access to service and utilization of services, including reductions in turnaround time, length of stay, waiting time, and turnover time. Notably, we found scarce outcomes regarding patient health, staff wellbeing, resource use, and savings. This paper, the first to investigate the dual intervention of DTs with lean or lean−Six Sigma in healthcare, summarizes the technical and organizational challenges associated with similar interventions, encourages further research, and promotes practical applications

Success Factors and Benefits of Six Sigma Implementation in Hospitals: A Systematic Review

This review explores critical success factors of Six Sigma implementation in hospitals and identifies the benefits. Data sources and Methodology: Prior studies on Six Sigma (SS) totaling 100 were selected from more than 100 journals. These studies came from numerous databases and are classified based on the year of publication. Journal names with corresponding number of papers selected are reported. The review reveals 25 critical success factors (CSF) necessary in the implementation of Six Sigma, encompassing numerous aspects of an organization such as managerial, statistical, and technical aspects. Twenty benefits derived from SS’s implementation are identified, including various improvements in terms of the organizations’ processes, financial performance, and quality of service. The success of Six Sigma implementation depends on several critical factors, some of which are best considered before its introduction, while others must be addressed during the process itself. Other factors are external and should be considered during and after its implementation. Not all Six Sigma initiatives are successful nor result in great benefits. Therefore, organizations must analyze their need for Six Sigma projects and base their decisions on the availability/presence of the CSF. Organizations, including hospitals, can gain numerous benefits from Six Sigma implementation but must first evaluate Six Sigma’s introduction and implementation against their abilities to achieve desired outcomes

WAITING TIME AND PATIENTS’ SATISFACTION

In line with Vision 2021, the UAE’s National Agenda has six pillars: providing world-class healthcare is one of them. It is hence not surprising that the UAE healthcare industry is allocating substantial weight to the element of quality. Patient-centered care is internationally becoming part of the quality domain. Patient-centered quality may be defined as “providing the care that the patient needs in the manner the patient desires at the time the patient desires”. This requires substantially more attention to learning about patients’ preferences. One of the main dimensions of patient-centered quality is timely access to care, which includes shorter waiting times and efficient use of physicians’ time. Long waiting time is a globally challenging phenomenon that most healthcare systems face; it is the main topic of this thesis. The thesis consists of two main studies. The first empirical study was conducted by interviewing a sample of 552 patients to assess their satisfaction with their waiting experience in UAE hospitals. The collected data allowed us to test several hypotheses that were formulated based on an extensive literature study to better understand the relationship between waiting time and certain variables. In the second study, a simulation model for a typical clinic was built from real data obtained from a public hospital in Abu Dhabi emirate, considering two types of patients’ arrival; by appointment and walk-in, to test the effect of delayed arrivals and number of resources on the waiting time. The objective of the simulation study was to determine effective strategies for reducing the patients’ waiting time. The results of both studies are presented and discussed, with some recommendations, managerial implications, and conclusions