Driving Improvement in Patient Care

Thompson, Debra N.; Wolf, Gail A.; Spear, Steven J.

doi:10.1097/00005110-200311000-00008

Cited by 92 publications

(79 citation statements)

References 2 publications

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“…Furthermore, although SB's rules originated in automobile manufacturing, they have been applied to hospital work (Fredendall et al 2009, Furman and Caplan 2007, Jimmerson et al 2005, Shannon et al 2007, Spear and Schmidhofer 2005, Thompson et al 2003, Toussaint et al 2010, Wysocki 2004). …”

Section: Prior Research On Operational Failures and Lean Manufacturinmentioning

confidence: 99%

Lean in healthcare – history and recent developments

Sloan¹,

Fitzgerald²,

Hayes³

et al. 2014

Journal of Health Organization and Management

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Abstract:The performance gap between hospital spending and outcomes is indicative of inefficient care delivery. Operational failures-breakdowns in internal supply chains that prevent work from being completed-contribute to inefficiency by consuming 10% of nurses' time (Hendrich et al. 2008, Tucker 2004. This paper seeks to identify organizational factors associated with operational failures, with a goal of providing insight into effective strategies for removal. We observed nurses on medical/ surgical units at two hospitals, shadowed support staff who provided materials, and interviewed employees about their internal supply chain's performance. These activities created a database of 120 operational failures and the organizational factors that contributed to them. We found that employees believed their department's performance was satisfactory, but poorly trained employees in other departments caused the failures. However, only 14% of the operational failures arose from errors or training. They stemmed instead from multiple organizationally-driven factors: insufficient workspace (29%), poor process design (23%), and a lack of integration in the internal supply chains (23%). Our findings thus suggest that employees are unlikely to discern the role that their department's routines play in operational failures, which hinders solution efforts. Furthermore, in contrast to the "Pareto Principle" which advocates addressing "large" problems that contribute a disproportionate share of the cumulative negative impact of problems, the failures and causes were dispersed over a wide range of factors. Thus, removing failures will require deliberate crossfunctional efforts to redesign workspaces and processes so they are better integrated with patients' needs.

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Section: Prior Research On Operational Failures and Lean Manufacturinmentioning

confidence: 99%

Lean in healthcare – history and recent developments

Sloan¹,

Fitzgerald²,

Hayes³

et al. 2014

Journal of Health Organization and Management

View full text Add to dashboard Cite

show abstract

“…We have identified examples of empirical research that provide evidence of management practices as part of case studies over short-term periods (see e.g. Thompson, Gail and Steven, 2003). Further, textbooks on organization theory and management practices often describe the development of management practices theoretically over long time spans, ranging from scientific management traditions to postmodernism and neo-institutionalism (Scott and Gerald, 2006).…”

Section: Introductionmentioning

confidence: 99%

Swedish healthcare management practices and quality improvement work: development trends

Elg

Stenberg

Kammerlind

et al. 2011

International Journal of Health Care Quality Assurance

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Purpose -This study aims at empirically examining developmental trends in management practices and improvement work in healthcare organizations.Design/methodology/approach -We surveyed the managers of all primary healthcare centers (n = 1031) and clinical hospital departments (n = 1542) nationwide in the spring of 2007. The response rate was 46%. This article compares results from this survey with a study that was made in 2003. A theoretical framework based on organizational inner context, organizational outer context, external environment and outcomes form the base for the analysis. Comparisons were made using an independent two-sample t-test.Findings -A general aspect, identified empirically, is the tendency toward increased external pressure on the leaders in their improvement work. Higher management decisions, patient pressure and decisions made by policymakers have increasingly influenced and shaped the choices made by health care managers about where to focus efforts of improvement. Three different trends are empirically identified and elaborated upon in the article: Take-control logics; practice-based improvement and patient-centeredness.Practical implications -Health care leaders should carefully design new management control systems so that they support healthcare micro systems in their improvement

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“…Lean thinking encourages each team member to monitor and develop ideas to improve the flow of process, so that everyone focuses continuously on the goal of eliminating waste. 14,15 This may be a novel idea to the health care sector, but if implemented in the right way, can dramatically change the way we provide care, with greater efficiencies and less delay. The procedural list and checkpoints utilized in our study (Table 1) is an example of how we tried to achieve improved patient flow by building quality into our process.…”

Section: Discussionmentioning

confidence: 99%

“…14,15,18,19 We will continue to monitor and improve this process of providing same day evaluation and treatment for bone and brain metastases; and we will apply the lean thinking ideas to other areas of our clinical care delivery service such as three-dimensional treatments, charge procedures and daily treatment flow. The real challenge is to go beyond the simple application of lean tools, which is what we do now, and to develop a lean culture of continuous questioning and improvement.…”

Section: Kim Et Almentioning

confidence: 99%

The Application of Lean Thinking to the Care of Patients With Bone and Brain Metastasis With Radiation Therapy

Kim

Hayman

Billi³

et al. 2007

JOP

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Purpose: Patients with bone and brain metastases are among the most symptomatic nonemergency patients treated by radiation oncologists. Treatment should begin as soon as possible after the request is generated. We tested the hypothesis that the operational improvement method based on lean thinking could help streamline the treatment of our patients referred for bone and brain metastases.Methods: University of Michigan Health System has adopted lean thinking as a consistent approach to quality and process improvement. We applied the principles and tools of lean thinking, especially value as defined by the customer, value stream mapping processes, and one piece flow, to improve the process of delivering care to patients referred for bone or brain metastases. Results and Conclusion:The initial evaluation of the process revealed that it was rather chaotic and highly variable. Implementation of the lean thinking principles permitted us to improve the process by cutting the number of individual steps to begin treatment from 27 to 16 and minimize variability by applying standardization. After an initial learning period, the percentage of new patients with brain or bone metastases receiving consultation, simulation, and treatment within the same day rose from 43% to nearly 95%. By implementing the ideas of lean thinking, we improved the delivery of clinical care for our patients with bone or brain metastases. We believe these principles can be applied to much of the care administered throughout our and other health care delivery areas.

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Driving Improvement in Patient Care

Cited by 92 publications

References 2 publications

Lean in healthcare – history and recent developments

Lean in healthcare – history and recent developments

Swedish healthcare management practices and quality improvement work: development trends

The Application of Lean Thinking to the Care of Patients With Bone and Brain Metastasis With Radiation Therapy

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