Lean Transformation Frameworks for Hospital Departments

Critical issues in hospitals include prolonged wait times and soaring expenditures. While Lean methods appear to be a solution to these issues, Lean implementations are difficult to replicate in different healthcare settings because of a lack of well-established methodologies. Therefore, this thesis applies a unified Lean approach to create transformation frameworks for three major types of hospital departments that are facing different challenges attributed to their underlying characteristics. The first part of this thesis discusses a framework for schedule-based and treatment-oriented outpatient departments. The framework identifies the best patient mix, schedule, and staffing levels to reduce wait times and improve the utilisation of critical resources. After implementing the framework, an oncology department can run under a one-day regime while reducing patient visit time by 36.3% and increasing the number of daily chemotherapy treatments by 38.6%. The second part of this thesis describes a framework for shared processes in outpatient departments in which scheduled and unscheduled patients coexist. The framework analyses system capability and devises efficient patient and staff schedules to meet demand with supply in a timely fashion. Implementing the framework in a radiology department results in a 21.4% increase in the number of elective patients and 77.1% and 37.2% decreases in the lead times of emergency patients and elective patients, respectively. The final part of this thesis demonstrates a framework for emergency departments receiving unscheduled patient visits. The framework manages the discharge process and plans staffing and materials to alleviate crowding. The estimated results in a case emergency department are a 50.8% reduction in patient length of stay and 41.5% decrease in occupancy rate of stretchers. The major theoretical contribution of this thesis is its adaptation of several tools, which are organised into a series of structured activities towards Lean systems for different types of hospital departments. In practice, each framework is a comprehensive and step-by-step guideline for hospital managers to follow in their application of Lean to serve more patients, decrease wait time, and use their resources more efficiently. Furthermore, the frameworks are expected to foster a culture of continuous process improvement and facilitate a hospital-wide Lean transformation

Mobilizing medicine: a design response to the accessibility and cost issues in health care

textNationally, there is increasing concern over the accessibility, cost, and quality of the American health care system. While the quality of the care given is generally out of the control of designers, it has received increased attention in recent years, as is evidenced in the trends of healing gardens, private patient rooms, and improved social settings. As beneficial as these trends are to the patients they serve, they often have a negative effect on overall accessibility and cost of care due to the constant construction and renovations needed and their largely urban presence. While quality health care is very important and should not suffer as a result, how can designers address nonenvironmental sustainability issues of cost and access in the American healthcare system? Due to the trend in increasing cases of chronic illness, as opposed to more pathogenic ailments of the past, the necessity for all healthcare settings to be highly controlled and sterile environments should be reevaluated. While less popular and not as fully developed as the typical facilities most Americans are familiar with, an increase in mobilized health care units could be a solution to the lack of economic and social access and sustainability in the current healthcare model while still providing safe, quality care. By examining current instances of mobile clinics, I will explore the design requirements necessary to make mobile clinics accessible and cost effective. In addition, I will look for facilitators and barriers to these systems, such as improvements in mobile communication technologies and lack of stakeholder support.Architectur

Contemporary Topics in Graduate Medical Education

Graduate medical education (GME) is a continually evolving, highly dynamic area within the complex fabric of the modern health-care environment. Given the rapidly changing regulatory, financial, scientific and technical aspects of GME, many institutions and programs face daily challenges of "keeping up" with the most recent developments within this ever-more-sophisticated operational environment. Organizational excellence is a requirement for the seamless functioning of GME programs, especially when one consider the multiple disciplines and stakeholders involved. The goal of the current book cycle, titled Contemporary Topics in Graduate Medical Education, beginning with this inaugural tome, is to provide GME professionals with a practical and readily applicable set of reference materials. More than 20 distinguished authors from some of the top teaching institutions in the US, touch upon some of the most relevant, contemporary, and at times controversial topics, including provider burnout, gender equality issues, trainee wellness, scholarly activities and requirements, and many other theoretical and practical considerations. We hope that the reader will find this book to be a valuable and high quality resource of a broad range of GME-related topics. It is the Editors' goal to create a multi-tome platform that will become the definitive go-to reference for professionals navigating the complex landscape of modern graduate medical education

Proposta de melhoria na avaliação econômica do Lean Healthcare : o caso do teleatendimento

A área da saúde é um ambiente de alta complexidade que possui atividades sem valor agregado a partir da perspectiva do paciente. Desta forma, há uma constante identificação dos desperdícios a serem eliminados, apesar da lacuna em relação à mensuração econômica da redução dos custos. Nesse contexto, esta dissertação tem como objetivo principal propor melhorias na avaliação econômica do Lean Healthcare. Para isso, realizou-se revisões sistemáticas da literatura com foco na aplicação do Lean Healthcare e do microcusteio TDABC na saúde. Além disso, discutiram-se aspectos teóricos do sistema de custos quanto aos métodos e princípios de custeio. Os achados das revisões indicaram que nos estudos de Lean Healthcare é escassa a avaliação econômica das melhorias propostas. Sob outra perspectiva, os estudos de microcusteio TDABC apresentam discussões limitadas do sistema de custeio, ou seja, não há uma visão ampla do processo estrutural hospitalar para a avaliação de impacto da melhoria. Portanto, neste estudo aplicou-se o microcusteio TDABC no processo de telemedicina com a proposição de avaliação da melhoria com o Lean Healthcare. A partir disso, analisaram-se, através dos princípios de custeio, as capacidades dos recursos e notou-se uma ociosidade dos profissionais médicos e da estrutura disponível para o teleatendimento. A análise de desperdícios do Lean Healthcare permitiu avaliar alternativas com o potencial de aumentar a quantidade de atendimentos, com a redução do tempo de espera e das perdas anormais do processo. Sendo assim, com os ajustes, houve uma redução no custo médio de cada atendimento de 24% em relação ao custo anterior. Ademais, com a melhoria, foi estimado que o tempo de espera mensal seja reduzido em 32%. Apesar dos ajustes necessários, a telemedicina foi uma eficiente ferramenta durante a pandemia e permitiu a expansão de serviço de pronto atendimento para consultas de baixa complexidade. Além disso, é de suma importância a disponibilização de um serviço que ultrapasse as dimensões continentais e proporcione a sua equidade no país.Healthcare is a highly complex environment that has activities without added value from the patient's perspective. Thus, there is a constant identification of waste to be eliminated, despite the gap in relation to the economic measurement of cost reduction. In this context, this dissertation has as main objective to propose improvements in the economic evaluation to Lean Healthcare. For this, systematic reviews of the literature were carried out with a focus on the application of Lean Healthcare and TDABC microcosting in health. In addition, theoretical aspects of the cost system were discussed in terms of costing methods and principles. The findings of the reviews indicated that in Lean Healthcare studies there is little economic evaluation of the proposed improvements. From another perspective, the TDABC microcosting studies present limited discussions of the costing system, that is, there is no broad view of the hospital structural process for assessing the impact of improvement. Therefore, in this study, the TDABC microcosting was applied in the telemedicine process with the proposition of evaluating the improvement with Lean Healthcare. Based on this, the capabilities of the resource were analyzed using the costing principles and it was an idleness of medical professionals and the structure available for teleservice. Lean Healthcare’s waste analysis allowed evaluating alternatives with the potential to increase the number of appointments, with a reduction in waiting time and abnormal losses in the process. Therefore, with the adjustments, there was a reduction in the average cost of each service of 24% in relation to the previous cost. Furthermore, with the improvement, it was estimated that the monthly waiting time is reduced by 32%. Despite the necessary adjustments, telemedicine was an efficient tool during the pandemic and allowed for the expansion of emergency care services for low-complexity consultations. In addition, it is of paramount importance to provide a service that goes beyond continental dimensions and provides equity in the country

Healthcare Access

Adequate healthcare access not only requires the availability of comprehensive healthcare facilities but also affordability and knowledge of the availability of these services. As an extended responsibility, healthcare providers can create mechanisms to facilitate subjective decision-making in accessing the right kind of healthcare services as well various options to support financial needs to bear healthcare-related expenses while seeking health and fulfilling the healthcare needs of the population. This volume brings together experiences and opinions from global leaders to develop affordable, sustainable, and uniformly available options to access healthcare services

Reducing attendances and waits in emergency departments : a systematic review of present innovations

Reducing the waits in emergency departments is important for patients and is a government priority. In order to reduce waits the whole system must be considered. The flow of patients before arrival at the emergency department determines the workload of the department. The staffing, resources and systems within the emergency department are key to providing high quality timely care. The flow of patients after leaving the emergency department until their return home will determine whether they can be discharged from the department in a timely manner. Despite the present focus on emergency care in the NHS there have been no reviews of the literature to inform the present changes to reduce waits

Technology acceptance model perceptions of operational staff on the implementation of advanced radiography equipment

Throughout the recent history of South Africa, the increasing requirements from state and private sector healthcare institutions have relied heavily upon medical imaging technologies for the purposes of improved patient healthcare and service quality standards. Developments in this field of healthcare have seen many interesting and challenging operational changes: from the first implementation and use of X-ray equipment demonstrated in Krugersdorp in 1899; to the current advanced digital systems found in the medical imaging services sector of healthcare. This research study measured the medical imaging operational staff perceptions about new advanced medical imaging equipment and technologies. The theory crossed the academic disciplines through a quantitative survey about technology, operations management and healthcare. Together with staff perceptions about future medical imaging technologies’ usefulness and ease of use, the findings may impact their daily operations within a conducive technology acceptance management paradigm.Thesis (MA) -- Faculty of Faculty of Business and Economic Sciences, 202

Technology acceptance model perceptions of operational staff on the implementation of advanced radiography equipment

Throughout the recent history of South Africa, the increasing requirements from state and private sector healthcare institutions have relied heavily upon medical imaging technologies for the purposes of improved patient healthcare and service quality standards. Developments in this field of healthcare have seen many interesting and challenging operational changes: from the first implementation and use of X-ray equipment demonstrated in Krugersdorp in 1899; to the current advanced digital systems found in the medical imaging services sector of healthcare. This research study measured the medical imaging operational staff perceptions about new advanced medical imaging equipment and technologies. The theory crossed the academic disciplines through a quantitative survey about technology, operations management and healthcare. Together with staff perceptions about future medical imaging technologies’ usefulness and ease of use, the findings may impact their daily operations within a conducive technology acceptance management paradigm.Thesis (MA) -- Faculty of Faculty of Business and Economic Sciences, 202