Purpose – This paper aims to explore if actions used at a hospital to manage a variable acute patient flow can be categorised using the concepts of lean, agile and leagile. Design/methodology/approach – Empirical evidence from a university hospital was gathered by interviews, internal documents, shadowing and participation in meetings. Identified actions used at both hospital level and departmental level are categorised as lean or agile, while combinations of actions are compared with different leagile approaches. Findings – Actions from every lean and agile category derived from literature are used at the hospital, however in varying extent. Many agile actions are reactive, indicating a lack of proactive measures. Actions that directly manage external variation are also few in numbers. Leagile approaches of all three combinations derived from literature are also used at the hospital. Research limitations/implications – As a single-case study is used, empirical generalisation to other hospitals cannot be deduced. Future research assessing the appropriateness of different actions for managing a variable acute patient flow is encouraged. Practical implications – The use of actions within both lean and agile categories indicate the possibility of combining these process strategies in hospitals, and not only focusing on implementing lean. By cleverly combining lean and agile actions, leagile approaches can be formed. Originality/value – The use of lean in health care has been a topic of research, while the use of agile has been sparsely researched, as well as the combination of the two.

. His research deals with integration and coordination of a supply chain, and the intersection between logistics and different strategic management issues such as dynamic capabilities, the strategy formation process and business models. Structured Abstract:Purpose To explore the involvement of middle management in forming strategies to manage variable acute patient flows at a hospital. Design/methodology/approach Empirical evidence from a university hospital was gathered via interviews, internal documents, observation and participation in meetings. The role of middle management in the development of strategies was analyzed using literature on middle management involvement. FindingsIn managing variable acute patient flows, middle management adopt a number of roles and behavioral characteristics that have been previously described in research. The role of facilitator is the most prominent, with middle managers prioritizing individual goals and strategies for the clinical departments that they manage before their collective responsibility for hospital performance. Unclear responsibilities and mandates within the organization, together with a lack of hospital-wide strategies concerning how the acute patient flow should be managed, are contributing factors to this behavior. Research limitations/implicationsThe research is based on an explorative, single case study methodology. Future research assessing the extent of different middle management roles in healthcare, in which more empirical data and quantitative analysis is conducted, is encouraged. Practical implicationsThere is a need for top management to establish long-term goals to enhance middle management roles when developing strategies for managing variable patient flows. Originality/value Middle management involvement in developing strategies for managing variable patient flows is a novel topic of research. The interface and division of tasks between top and middle management is crucial for successful strategies in managing variable patient flows. Middle management involvement in handling variable patient flows Abstract PurposeTo explore the involvement of middle management in forming strategies to manage variable acute patient flows at a hospital. Design/methodology/approach Empirical evidence from a university hospital was gathered via interviews, internal documents, observation and participation in meetings. The role of middle management in the development of strategies was analyzed using literature on middle management involvement. Findings In managing variable acute patient flows, middle management adopt a number of roles and behavioral characteristics that have been previously described in research. The role of facilitator is the most prominent, with middle managers prioritizing individual goals and strategies for the clinical departments that they manage before their collective responsibility for hospital performance. Unclear responsibilities and mandates within the organization, together with a lack of hospital-wide strategies concerning how the acute...

Introduction In 2015, Sweden initiated the implementation of standardised cancer care pathways (CCPs). With short, nationally imposed target times from diagnosis to first treatment, the issue of crowding out effects has been debated. This study investigate whether the implementation of CCPs is associated with longer waiting times for surgery, radiology scans and pathology analyses for other patient groups. Methods Data from the internal computer systems used in radiology, pathology and surgery to plan and follow the production at a county hospital in Sweden during 2014–2017 were analysed. By utilising the different priority categories used in these specialties, changes in waiting times before and after the implementation of CCPs could be analysed. Results The results are consistent with an association between the implementation of CCPs and longer waiting times for the priority category prioritised immediately after the CCP category in all specialties. In addition, none of the lowest priority categories within each subspecialty have experienced increased waiting times after CCP implementation. Discussion These results are consistent with a change in prioritisation where CCP patients are receiving shorter waiting times after CCP implementation at the expense of other patient groups. Crowding out effects related to CCP implementation have not been previously researched. This study therefore fills a gap in present literature. With an increased awareness of these challenges, and a more holistic perspective in the implementation process, actions can be put in place to identify and counteract crowding out effects.

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