POLICY DEPLOYMENT FOR CONTINUOUS IMPROVEMENT IN PUBLIC HOSPITALS. From Kaizen Initiatives to a Kaizen Initiative Program: an action research

Purpose. Although kaizen methodology is increasingly applied and investigated in healthcare, most of the current literature describes successful kaizen initiatives and report their technical outcomes (e.g. Dickson et al., 2009; Laganga, 2011). Aspects related to the deployment of the kaizen approach across healthcare organizations are often neglected by the scholars. Thus, this thesis aims at filling this gap by developing and testing a theoretical framework to understand how the continuous improvement approach could be adopted and adapted to a public hospital and what features should be considered as key drivers of a successful implementation. In particular, this study uses a policy deployment perspective to investigate the linkage between decisions at the strategic level within healthcare organizations and those regarding the implementation of a set of kaizen initiatives over time (Kaizen Initiative Program \u2013 KIP). Design/Methodology/Approach. This study uses the action research methodology to develop theoretical and practical insights from a complex endeavour as kaizen implementation in public hospitals. The research is divided in four main cycles: Design; Training; Kaizen (Implementation and Monitoring) and Evaluation. Each cycle includes: a pre-step for understanding context and purpose; a six main-step stage (to gather, feedback and analyse data, to plan, implement and evaluate actions) and a meta-step (to monitor) (Coughlan and Coghlan, 2002). The researcher played an active role and adopted the process consultation model to support the healthcare professionals engaged. Thus, the researcher could investigate in real time what characterized a continuous improvement program and how it has been deployed across the hospitals involved. Findings. By investigating how the continuous improvement approach is implemented in public hospitals this study describes and discusses the practical problems addressed and difficulties emerging over time at both strategical and operational level, and at team and organisational level during the action research. In particular, this study provides: 1) a tested framework for applying a KI Program at both organisational and system level (e.g., regional/healthcare district); 2) the key features/practices of the KI Program (what) and their sequence for a successful implementation (when); 3) the successful deployment modalities of the KI Program (how) to properly select the kaizen teams and initiatives (e.g., the periodic briefings between the managers from the strategic level and the kaizen teams). Practical implications. Results provide a structured framework for healthcare practitioners and managers who are interested in successfully launching and sustaining a KI Program. This framework could help hospital managers to link the strategic level decisions with continuous improvement actions at the operational level, avoiding the only use of bottom-up and pop-corn initiatives. Originality. The research proposes a tested framework emerging from the action research for successfully selecting kaizen initiatives that are linked to the strategic objectives of healthcare organizations. Differently from the existing kaizen literature, this research engaged seven different and independent hospitals that have been performing their first kaizen experience simultaneously and which belong to the same regional healthcare system and are led by a unique regional administration office. Keywords: continuous improvement, kaizen, hospital, kaizen programPurpose. Although kaizen methodology is increasingly applied and investigated in healthcare, most of the current literature describes successful kaizen initiatives and report their technical outcomes (e.g. Dickson et al., 2009; Laganga, 2011). Aspects related to the deployment of the kaizen approach across healthcare organizations are often neglected by the scholars. Thus, this thesis aims at filling this gap by developing and testing a theoretical framework to understand how the continuous improvement approach could be adopted and adapted to a public hospital and what features should be considered as key drivers of a successful implementation. In particular, this study uses a policy deployment perspective to investigate the linkage between decisions at the strategic level within healthcare organizations and those regarding the implementation of a set of kaizen initiatives over time (Kaizen Initiative Program \u2013 KIP). Design/Methodology/Approach. This study uses the action research methodology to develop theoretical and practical insights from a complex endeavour as kaizen implementation in public hospitals. The research is divided in four main cycles: Design; Training; Kaizen (Implementation and Monitoring) and Evaluation. Each cycle includes: a pre-step for understanding context and purpose; a six main-step stage (to gather, feedback and analyse data, to plan, implement and evaluate actions) and a meta-step (to monitor) (Coughlan and Coghlan, 2002). The researcher played an active role and adopted the process consultation model to support the healthcare professionals engaged. Thus, the researcher could investigate in real time what characterized a continuous improvement program and how it has been deployed across the hospitals involved. Findings. By investigating how the continuous improvement approach is implemented in public hospitals this study describes and discusses the practical problems addressed and difficulties emerging over time at both strategical and operational level, and at team and organisational level during the action research. In particular, this study provides: 1) a tested framework for applying a KI Program at both organisational and system level (e.g., regional/healthcare district); 2) the key features/practices of the KI Program (what) and their sequence for a successful implementation (when); 3) the successful deployment modalities of the KI Program (how) to properly select the kaizen teams and initiatives (e.g., the periodic briefings between the managers from the strategic level and the kaizen teams). Practical implications. Results provide a structured framework for healthcare practitioners and managers who are interested in successfully launching and sustaining a KI Program. This framework could help hospital managers to link the strategic level decisions with continuous improvement actions at the operational level, avoiding the only use of bottom-up and pop-corn initiatives. Originality. The research proposes a tested framework emerging from the action research for successfully selecting kaizen initiatives that are linked to the strategic objectives of healthcare organizations. Differently from the existing kaizen literature, this research engaged seven different and independent hospitals that have been performing their first kaizen experience simultaneously and which belong to the same regional healthcare system and are led by a unique regional administration office. Keywords: continuous improvement, kaizen, hospital, kaizen progra

Clinical signs, telemedicine and online consultations in head and neck diseases during the SARS CoV-2 pandemic: an Italian experience

SUMMARY Objective. The aim of this paper is to describe the application of a telemedicine (TM) syn-chronous model designed to deliver care during the Coronavirus Disease 2019 (COVID-19) pandemic to patients with head and neck disease. Methods. The first step was to identify the classes of patients eligible for tele-examination. Mild, flu-like symptomatology represents the characteristics of the typical patient who is a candidate for tele-examination. The standard requirements for TM include a computer associated with a digital camera, alternatively a smartphone or tablet. The TM platform is based on the Lifesize™ software, which can be freely downloaded. Results. The overall number of teleconsultations was 178, of which 163 (91.5%) were man-aged at home, while 15 (8.5%) were invited for in-presence examination. The number of patients coming from general practitioners was 98 (55.1%), from spoke units 52 (29.2%), patients needing prompt stabilisation and transfer to the hub centre were 20 (11.2%,) while 8 (4.5%) were immediately fast-tracked in the spoke unit after multi-professional tele-con-sultation. Conclusions. Telemedicine improves organisational models, and provides a scalable solu-tion to overcome problems of overcrowding, resources and time. Should these develop-ments continue, we could face to a gradual transition to a more digital and efficient health-care system

Shifting operations to Factory of the Future: a survey of European manufacturing companies

Factory of the Future (FoF) defines a variety of production technologies and IT solutions enabling the digitisation and automation of operations. Shifting to FoF implies both disruptive changes and far-reaching opportunities in improving competitiveness of manufacturing companies. Building on a literature review and exploratory survey conducted in a European project, this work outlines current state, challenges and gaps of FoF issues from literature and empirical point of view. It derives clusters in relation to strategies, drivers, enablers, benefits and barriers of FoF technologies adoption; organisational structures, skills and competencies required; roles of the value chain partners; importance of performance management

Current Trends in the Development and Use of Personalized Implants: Engineering Concepts and Regulation Perspectives for the Contemporary Oral and Maxillofacial Surgeon

The recently adopted Medical Device Regulation (MDR) has finally entered into force on 26 May 2021. As innovation and especially the advent of customized prostheses has deeply modified many surgical procedures in our discipline, it is imperative for the contemporary surgeon to become aware of the impact that the MDR will have on many aspects, including the choice of the manufacturer, the evaluation of the devices, point-of-care 3D printing labs, and medical software. In this paper, the authors tried to identify the cultural gaps in clinical practice that the MDR is supposed to fill. To achieve this purpose, a task force of experts was reunited, including CMF surgeons with direct expertise in medical software and 3D printing, mechanical and material engineers, facing the topic of the MDR from a multidimensional perspective. In this article, surgeons and engineers review many crucial aspects concerning the points of the regulation that mostly affect the field of implantable devices for the cranio-maxillo-facial skeleton. The result of interdisciplinary research is a paper aiming to provide surgeons with the knowledge on the fundamental processes of additive manufacturing, increasing the clinician’s awareness on the evaluation of a customized implant before surgery and on the underlying regulatory framework