Lean thinking turns ‘time is brain’ into reality

Li, Li Min; Johnson, Sharon A.

doi:10.1590/0004-282x20150047

Cited by 6 publications

(9 citation statements)

References 25 publications

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“…For this reason, the entire process should be improved considering together the pre-hospital times (the onset to alarm time and the alarm to door time), and the DNT in further researches [7].…”

Section: Discussionmentioning

confidence: 99%

“…As stressed by Li ad Johnson [7], rather than requiring that everything goes faster, the entire value stream should be analysed, in order to eliminate the activities that not add value.…”

Section: Lean Management To Improve Stroke Carementioning

confidence: 99%

“…However, searching on academic databases (such as Scopus of Web of Science), combining the words "stroke" with "lean management" (with the boolean operator AND), few papers regard the adoption of HLM for caring stroke (e.g., [7,13,[19][20][21]). Moreover, in these papers the implementation process of the HLM project is not sufficiently detailed.…”

Section: Lean Management To Improve Stroke Carementioning

confidence: 99%

“…As stressed by Gomez [6] "time is brain". In the literature, it is clear that shorter Onset to Treatment Time (OTT) (time from the symptom onset to the treatment) and Doorto-Needle Time (DNT) (time from the arrival in emergency department to the treatment) provoke improved clinical outcomes and fewer complications [7]. Each wasted minute is determinant in the stroke care; for instance, lack of treatment of a supratentorial ischemic stroke implies the loss of 1.9 million neurons per minute, which means almost 3.6 years of aging, as estimated by Saver [8].…”

Section: Introductionmentioning

confidence: 99%

“…In order to comply with this time constraint, managerial approaches can be helpful. Li and Johnson [7] mentioned studies of process improvement where the OTT has been significantly reduced. Educational campaign to recognize the stroke symptom and the use of mobile tools have decreased the pre-hospital times [9,11].…”

Section: Introductionmentioning

confidence: 99%

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Organizational solutions to improve timeliness and effectiveness of the stroke care

et al. 2016

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Background: 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. Methods: 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.Results: 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. Conclusions: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.

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Section: Discussionmentioning

confidence: 99%

“…As stressed by Li ad Johnson [7], rather than requiring that everything goes faster, the entire value stream should be analysed, in order to eliminate the activities that not add value.…”

Section: Lean Management To Improve Stroke Carementioning

confidence: 99%

Section: Lean Management To Improve Stroke Carementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Organizational solutions to improve timeliness and effectiveness of the stroke care

et al. 2016

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A systematic review of Lean in healthcare: a global prospective

Antony¹,

Sunder

Sreedharan

et al. 2019

IJQRM

116

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Purpose Fostered by a rapid spread beyond the manufacturing sector, Lean philosophy for continuous improvement has been widely used in service organizations, primarily in the healthcare sector. However, there is a limited research on the motivating factors, challenges and benefits of implementing Lean in healthcare. Taking this as a valuable opportunity, the purpose of this paper is to present the key motivating factors, limitations or challenges of Lean deployment, benefits of Lean in healthcare and key gaps in the literature as an agenda for future research. Design/methodology/approach The authors used the secondary data from the literature (peer-reviewed journal articles) published between 2000 and 2016 to understand the state of the art. The systematic review identified 101 articles across 88 journals recognized by the Association of Business Schools ranking guide 2015. Findings The systematic review helped the authors to identify the evolution, current trends, research gaps and an agenda for future research for Lean in healthcare. A bouquet of motivating factors, challenges/limitations and benefits of Lean in healthcare are presented. Practical implications The implications of this work include directions for managers and healthcare professionals in healthcare organizations to embark on a focused Lean journey aligned with the strategic objectives. This work could serve as a valuable resource to both practitioners and researchers for learning, investigating and rightly adapting the Lean in the healthcare sector. Originality/value This study is perhaps one of the comprehensive systematic literature reviews covering an important agenda of Lean in Healthcare. All the text, figures and tables featured here are original work carried by five authors in collaboration (from three countries, namely, India, the USA and the UK).

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Stroke treatment: metrics and processes

André

2015

Arq. Neuro-Psiquiatr.

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T he proportion of cerebral infarct patients receiving intravenous thrombolysis is a sensible and logic marker of stroke care quality. A high number of treated patients reflects fast collaborative work in acute stroke-ready hospitals 1 . Tipically, these hospitals have structured acute stroke teams, carefully studied and written protocols, fast laboratory and neuroimaging testing, and exhibit major involvement of emergency medical services and personnel 2 .Increasing the number of IV rT-PA treated patients should be considered a high priority for acute stroke hospitals. This depends on a coordinated effort of policy makers, Health insurance companies and local facilities. Federal, State and local Government should be responsible for adequate funding of public services, human and technological resources (e.g., telethrombolysis, immediate rescue of patients in remote areas); coordinate different public and private agents (e.g., primary or comprehensive stroke centers and more simple facilities benefiting from effective telemedicine use and drip and ship strategies); legislate and supervise the adequacy of services provided, and improve public education about stroke signs and symptoms, preparedness and effective action 1,3 . Any hospital dealing with a significant number of acute stroke patients should carefully develop and control the processes involved. Ideally, this should include all evaluation and treatment phases -from pre-hospital management to post-discharge care and rehabilitation . The authors focus on the hyperacute phase assessment and management. They emphasize the need of a critical evaluation of the chain of steps that may constitute barriers to speed the use of IV rT-PA. Improvement of those steps, gaining more time and leading to a higher number of patients treated within the golden 90 minutes-window is suggested. They provide references from institutions that have achieved a significant decrease in average onset-to-treatment time (OTT) to IV thrombolysis. Unfortunately, this does not necessarily result in better outcomes. These somewhat deceiving final results could be due to a non-significant increase in the proportion of patients treated within the 90-minute frame.Constant effort to improve workflow metrics should be part of the institution's commitment to high-quality stroke management. It should be acknowledged, however, that mean or median OTT cannot tell us the whole story 9,10 . Central tendency measures may represent a final result of divergent forces: greater symptom recognition by the public and more efficient hospital processes, and, on the other hand, the parallel inclusion of more patients in the extended 3 to 4.5 hour-window.Li and Johnson also propose the use of a specific approach -Lean-Six-Sigma -to rationally speed the management processes emphasizing on-site observation of the entire chain of steps 8 . This is followed by preferential intervention on those steps that can add most value -i.e., speed -to the process. The method has already been applied to hospital processes 11 . U...

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Lean thinking turns ‘time is brain’ into reality

Cited by 6 publications

References 25 publications

Organizational solutions to improve timeliness and effectiveness of the stroke care

Organizational solutions to improve timeliness and effectiveness of the stroke care

A systematic review of Lean in healthcare: a global prospective

Stroke treatment: metrics and processes

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