LEAN concept – possibilities of implementation and improvement of business processes in public healthcare organizations

Uvod: Osnovni je postulat lean koncepta da se veća efikasnost procesa rada može postići kroz proces kontinuiranog poboljšanja. To znači eliminiranje otpada i maksimiziranje aktivnosti koje dodaju vrijednost. Zdravstveni sustavi u Nizozemskoj, Velikoj Britaniji, Italiji i Sjedinjenim Američkim Državama implementirali su lean koncept. Cilj rada: Ispitati mišljenje zdravstvenih radnika javne bolnice na području Sarajeva o mogućnostima unaprjeđenja poslovnih procesa implementacijom lean koncepta. Metoda: Istraživanje je provedeno kao presječna studija u javnoj bolnici na području Sarajeva. Upitnik je poslane-poštom zdravstvenim radnicima. Obuhvaćen je 91 ispitanik oba spola (doktori medicine, specijalizanti, diplomirane medicinske sestre, medicinske sestre i administrativno osoblje). Rezultati: Utvrđena je pozitivna korelacija stavova o efektivnosti i efikasnosti poslovnih procesa. Prema mišljenju ispitanika, veća efektivnost poslovnih procesa pridonosi većoj efikasnosti (r = 0,846; p < 0,05). Spearmanov koeficijent rs = 0,81 pokazuje jaku povezanost efektivnosti i efikasnosti poslovnih procesa. Zaključak: Istraživanje je pokazalo da postoji pozitivan stav o utjecaju lean koncepta na poboljšanje učinkovitosti poslovnih procesa. Očekivani pozitivni učinciimplementacije lean koncepta manifestiraju se kroz: brže pružanje usluge pacijentima, smanjivanje vremena čekanja usluge i generalno poboljšanje poslovnih procesa.Introduction: The basic postulate of the lean concept is that greater efficiency of the work process can be achieved through a process of continuous improvement, which aims to eliminate waste and maximize activities that add value.The Netherlands, Great Britain, Italy and the United States were examples of healthcare systems that implemented the lean concept. Aim: To examine the opinion of health workers of a public hospitals in the Sarajevo area about the possibilities of improving business processes by implementing the lean concept. Method: The cross-sectional study was conducted using a questionnaire. The questionnaire was sent to the e-mail addresses of health workers of public health organizations. 91 respondents of both sexes (doctors of medicine, residents, registered nurses, nurses and administrative staff) were included. Results: A positive correlation was establishedin the attitude toward the effectiveness and efficiency of business processes. According to the participant’s opinion, the greater effectiveness of business processes contributes to greater efficiency (r=0.846; p<0,05). Spearman’s coefficient rs=0.81 shows a strong connection between the effectiveness and efficiency of business processes. Conclusion: The study showed that there is a positive attitude towards the impact of the lean concept on improving the efficiency of business processes. The reducexpected positive effects of the implementation of the lean concept are manifested through faster provision of services to patients, reduction of service waiting times and general improvement of business processes

Tomographic ventilation/perfusion lung scintigraphy in the monitoring of the effect of treatment in pulmonary embolism: serial follow-up over a 6-month period.

BACKGROUND: Pulmonary embolism (PE) is a severe condition with nonspecific symptoms. Diagnosis relies on medical imaging but follow-up is currently based on clinical symptoms and general risk factors. The duration of anticoagulant treatment after an acute episode of PE is still subject to debate and the best method of identifying the risk of recurrence in individual patients is undefined. Tomographic lung scintigraphy [ventilation/perfusion single photon emission computed tomography (V/P SPECT)] has improved the diagnostic accuracy with regard to PE but has not been evaluated for PE follow-up. AIM: The aim of this prospective study was to quantitatively follow the natural history of treated PE using V/P SPECT, which could prove helpful in defining an anticoagulant treatment regime for individual patients. METHODS: Of 83 consecutive patients with clinically suspected PE examined with V/P SPECT, 23 patients with confirmed PE were followed by serial V/P SPECT examinations over a 6-month period. All patients were also followed clinically. RESULTS: The mean relative decrease in PE extent compared with the time of diagnosis was 54±26% at 2 weeks, 79±30% at 3 months, and 82±30% at 6 months. Significant resolution of mismatched perfusion defects occurred between V/P SPECT controls within the first 3 months of anticoagulation (P<0.001) but not thereafter. V/P SPECT identified four patients with chronic PE, even though all patients were free from symptoms at 3-month follow-up. CONCLUSION: Follow-up of PE with V/P SPECT is feasible to evaluate treatment effectiveness in individual patients and to identify patients that develop chronic PE. This study also confirms that resolution of perfusion defects after PE occurs within the first 3 months of treatment. It is therefore recommended that V/P SPECT follow-up should be considered at 3 months after diagnosis

Impact of ventilation/perfusion single-photon emission computed tomography on treatment duration of pulmonary embolism.

The aim of the study was to establish whether the duration of anticoagulant (AC) therapy can be tailored, on an objective basis, by using ventilation/perfusion single-photon emission computed tomography (V/P SPECT) and to assess the extent of residual perfusion defects over time. In particular, we addressed the following: (a) is the extent of perfusion recovery at 3 months of initial pulmonary embolism (PE) diagnosis a satisfactory criterion for deciding the duration of oral AC? (b) Is it safe to withdraw AC at 3 months if perfusion recovery is complete

SEASONAL VARIATION OF THE PHYSICAL AND CHEMICAL PARAMETERS OF WILD GENOTYPES OF CORNELIAN CHERRY (CORNUS MAS L.)

The paper reports the physical and chemical characteristic in fresh fruit from two populations of cornelian cherry (Cornus mas L.) wild genotypes originated from Bosnia and Herzegovina during the two years 2012 and 2013. Fruits were assayed for physical properties (fruit and stone weight, fruit length, width, thickness, and stone length and width) and soluble solids, total acidity, reducing sugar, ascorbic acid, total phenol and anthocyanin contents. The cornelian cherries weighed from 1.6 g (Bugojno area, 2012 year) up to 2.1g ( Konjic area, 2012 year). Ascorbic acid content ranged from 253.62 (Bugojno area, 2012) up to 440.60 (Konjic area, 2013) mg 100g-1 fresh weight. Anthocyanin content ranged from 389.10 (Konjic area, 2012) up to 398.92 (Bugojno area, 2012) mg cyanidin-3- glucoside equivalents 100 g-1 fresh weight whereas phenol content ranged from 2158.55 (Konjic area, 2012) up to 2750.38 (Konjic area, 2013) mg gallic acid equivalents 100 g-1 fresh weight