Lean Management: organizational innovations in hematological Day-Hospitals

Background. Lean Thinking is a management method which, despite its industrial origins, has spread in the health-care environment too. Objective. To describe the path followed and the results reached implementing Lean Thinking in four case studies. Methods. Such case studies were conducted in as many hematological Day-Hospitals (DHs), located in Central-Italy. At the beginning of each study, the DH internal processes, activity volumes and patient flows were analyzed and satisfaction questionnaires were administered to both operators and patients. Based on the returned questionnaires, deficiencies were focused on; for each deficiency data was collected and objectives defined. Following such definitions, the analysis of inefficiency causes was performed and countermeasures were identified. In the final meeting the results were assessed and monitoring/maintenance methods were defined. All these steps were supported by Lean Thinking instruments for analysis and solution. Results. Activity organization and patient satisfaction improved everywhere. Time losses and workloads imbalances were minimized in two DHs, particularly through higher standardization in the management of clinical-administrative documents. In another DH, the output capacity of the hospital pharmacy and the workflows in the DH were aligned with respect to the course of the day, so reducing delays in the delivery of therapies. Appointment planning was improved in the fourth DH, standardizing time slots (15-minutes) necessary for each therapy, so optimizing the number of stations (beds and chairs) used. Conclusions. Poor management of health care facilities can affect efficiency, security and quality of services provided. Lean Thinking is a valid method to address such problems

organizational solutions to improve timeliness and effectiveness of the stroke care

Saving time means saving neurons in stroke care process. Managerial and organizational solutions that lean the processes should be considered in order to overcome the effects of stroke, which is the second worldwide cause of death. The purpose of the paper is to understand how Health Lean Management (HLM) can be adopted to achieve a more efficient stroke care process. In this peculiar context, efficiency enhancement leads to safety and effectiveness results. For this reason, the investigated projects have been recognized as Lean & Safety (L&S) projects, being HLM projects reporting patient safety improvements. Due to the peculiarity of the project to investigate, a holistic case study has been conducted in a university hospital of Tuscany region. Thanks to the research framework developed in the literature for L&S projects, data regarding motivations, objectives, organizational and managerial aspects, outcomes, enablers and obstacles of the project have been collected and analysed. A multidisciplinary team, already trained on HLM and supported by the top management, was created and the step-by-step Six Sigma approach was adopted. After a mapping phase, a value stream map was created, Key Performance Indicators were defined and, finally, the Door To Needle (DTN) times and the modified Rankin Scales (mRS) were measured. Thanks to root cause analysis, the identified wastes were analyzed and intervention actions were defined and implemented. They regarded mainly different organizational interventions and they led to a decrease of both DTN times and mRS. The analysed project has demonstrated how it is possible to obtain relevant operational and clinical outcomes through organizational solutions. The analysis of this project, in which pursuing efficiency has led to safety and effectiveness results, has demonstrated how these different performances are linked each other in some peculiar care processes, in which shorter time means more effective and safer care, as in the stroke case. The implementation of L&S projects can improve care processes, providing a contribution to realize a more efficient, effective and safer healthcare system

Performance enhancement and continuous improvement in Healthcare: How Lean Six Sigma “hits the target”

This article explores the potentials of Lean Six Sigma (LSS) in Healthcare, presenting and discussing one case study developed adopting an action research approach. The article aims are threefold: a) evaluate performance improvement in the Healthcare institution under analysis; b) discuss the potentialities of LSS tools and principles when applied to Healthcare organizations; c) highlight the factors enabling a LSS intervention in a Healthcare setting. The expected results are multifaceted. First, improvements are anticipated to relate to the performance of professionals in terms of increased efficiency, as well as to cost savings and time reductions in providing care services. Second, the case study underlines that Healthcare institutions would greatly benefit from a combined use of Lean and Six Sigma. Third, the case study is presented as a successful implementation of LSS due to a few key factors: institutional leadership, communication, personnel training, and employee empowerment

Il lean thinking tra efficienza, efficacia e valore nell’azienda pubblica: il caso dell’azienda ospedaliera universitaria senese

Il contributo discute le potenzialità e le condizioni di applicabilità del Lean Thinking (LT) all’inter- no delle amministrazioni pubbliche (AP), presentando uno specifico caso in ambito sanitario. Le finalità perseguite con il lavoro sono due: a) mostrare come sia possibile applicare i principi e gli strumenti tipici del LT in settori di produzione di servizi pubblici; b) contribuire allo sviluppo di un framework teorico che possa essere di ausilio ai fini della individuazione e comprensione dei principali elementi di successo per una positiva e sostenibile implementazione dei principi e degli strumenti Lean nelle AP, con specifico riferimento al settore della Sanità analizzato in questo lavoro e in un’ottica di generazione di “valore pubblico”

Management simulations for Lean healthcare: exploiting the potentials of role-playing

Purpose: The purpose of this paper is to investigate the potentials of role-playing (RP) both in training healthcare (HC) professionals to implement tools and improvement actions based on Lean principles, and in supporting group discussion and the sharing of different competencies for the development of Lean HC. Design/methodology/approach: The paper presents the case study of an RP simulation called LEAN HEALTHCARE LAB, which is used to train HC professionals at Siena University Hospital. The paper reports and discusses the results of a specific two-day simulation session and of a questionnaire that was distributed to gather feedback from the participants. Findings: The paper verifies the potentials of RP to be a powerful educational and training tool that is able to stimulate the HC participants to apply Lean thinking principles and share their competencies in collaborative decision-making processes. Research limitations/implications: The study provides data in reference to one single simulation session, although the game has already been applied several times in different HC organizations with very similar outcomes. Moreover, a more in-depth analysis of players’ perceptions and decisions could be performed using different tools in addition to the adopted questionnaire. Practical implications: RP games (RPGs) are effective training and educational tools for HC professionals. They offer benefits and learning conditions which are definitely different if compared with more conventional education programs for HC professionals. Originality/value: While previous studies have extensively discussed the potentialities of RPG and simulations in training programs, only a few articles have discussed the RP adoption for Lean thinking and even less to educate HC professionals on Lean principles and tools

Engaging professionals with serious games: The Lean Healthcare Lab at Siena University Hosp

• Purpose: This article aims to stimulate interest in the potentials of serious games within organizations. Through the examination of a case study, emphasis is given to serious games designed for healthcare organizations that are adopting Lean Thinking principles and tools. • Design/methodology/approach: The article discusses how serious games can be designed and implemented in practice by describing a case study based on a healthcare organization. The program, now in its second year, has been used extensively to train healthcare professionals. • Findings: The article is based on the authors’ firsthand experience with serious games and the outcome of several projects carried out in the healthcare setting under analysis. Serious games were found to be powerful training and management development tools as well as engaging environments for professionals. Specifically, the Lean Healthcare Lab supported professionals in their use and implementation of several Lean principles and techniques. • Research implications: The article suggests the opportunity to evaluate the effectiveness of serious games also to improve team performance and develop leadership skills. • Practical implications: Serious games have an enormous potential in sustaining processes of both individual and organizational learning, as well as facilitating improved teamwork. Moreover, serious games are very effective educational tools when compared to more conventional programs. • Originality/value: The approach described in this study can be used to design and implement serious games in any type of organization, in particular, those employing highly skilled professionals. Additionally, this article highlights how serious games can provide learners with a simulated close-to-reality environment where they are challenged to develop policies and use a variety of Lean and management tools

Applicazione della metodologia SMED per il miglioramento delle operations nelle sale operatorie. Il caso Azienda Ospedaliera Universitaria Senese

In molte strutture sanitarie, la riduzione dei tempi di cambio paziente in sala operatoria è un tema molto importante. Questa innovativa ricerca, fra le prime nel sue genere, condotta tramite la metodologia dell’action research, vuole analizzare come i tempi di changeover possano essere migliorati tramite l’utilizzo dello SMED (Single Minute Exchange of Die), un metodo per ridurre gli sprechi nei processi di set-up. La ricerca è stata sviluppata nell’ambito di una sala operatoria della Azienda Ospedaliera Universitaria Senese. La metodologia deriva dal lean thinking giapponese ed è particolarmente utilizzata nel mondo manifatturiero; l’obiettivo è quello di ridurre il più possibile i tempi per passare da un intervento chirurgico al successivo (tempo di set-up). I risultati dimostrano che il tempo di cambio è stato ridotto significativamente, così come la variabilità tra un paziente e il successivo, seguendo alcuni principi base: l’identificazione delle attività esterne e di quelle interne, l’analisi di ciascuna attività, ricerca di soluzioni a basso costo di realizzo e riduzione del tempo di cambio. Il progetto, dal punto di vista delle performance, ha portato a un abbattimento dei tempi di cambio paziente nonché a una riduzione degli interventi rinviati e di quelli conclusi oltre l’orario di chiusura previsto. Ma l’aspetto più importante è forse quello del miglioramento organizzativo apportato