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The goal of this study was to test the hypothesis that reintroduction of Continuous Performance Improvement (CPI) methodology, a lean approach to management at Seattle Children's (Hospital, Research Institute, Foundation), would facilitate engagement of vivarium employees in the development and sustainment of a daily management system and a work-in...
Citations
... A daily management system with a work-inprocess board achieved up to 17% time reduction in its research sections. 12 Initiatives aiming at streamlining selected research processes were sporadically identified. Gillies et al report that patient recruitment and retention in clinical trials may be enhanced in studies with outcomes relevant to potential participants and their clinicians. ...
Waste in research has been well documented, but initiatives to reduce it are scarce. Here, we share our initial experiences of implementing Lean thinking and visual management into hospital research units in the Region of Southern Denmark. A Transformation Guiding Team (TGT) anchored in the top management was established with participation from leaders, researchers and patient representatives. The role of the TGT was to implement Lean methods, considering patients as primary end-users of the research results. This is in line with an explicit decision on setting patient values first in clinical settings at participating hospitals. The leaders of the research units were instructed in Lean thinking and Lean methods during a five-module course focusing on increasing value and reducing waste in research production. Initial experiences were that Lean tools could create a patient-centred vision that through visual management could identify waste in work processes. Concerns were lack of evidence for using Lean methods in research leadership and that the model itself could be a time consumer. Some lessons learnt were that adding Lean tools in research leadership should not just provide increased research productivity, but also improve other important key performance indicators such as quality of research and patient-relevant results. We intend to evaluate the value of the initiative by follow-up research and publish the outcome of key behavioural and key performance indicators.
... Moreover, and ultimately important to Lean principles is the respect for the human condition of operators [12] and the recognition of the importance of teams for Lean success [4]. Being the creation of flow in the production system, a fundamental goal of lean [13], in order to achieve an efficient Pull Production System's implementation, the problems of the current production system must be analyzed. To do that, Value Stream Mapping (VSM) tool is the most common tool referred in the literature [14]. ...
This work, developed as a case study, propose, describe, and evaluates an implementation of a pull system in a SME company producing polymeric components for the automotive industry. The production system of the company was based on the push paradigm, which creates high stock levels and high lead times. The main purpose was to develop a pull production system controlled by Kanbans in the painting line. To achieve this goal, this case study demonstrates the application of relevant lean tools, such as, VSM, SMED, Kanban System, Supermarkets and Leveling. Through the SMED’s application, it was possible to reduce the setup times in 38% and make annual earnings of approximately 83000€. The application of a Kanban System, Leveling and Supermarket enabled the WIP’s reduction between injection and painting in 56% and, also, between painting and expedition in 45%. Also, the lead time decreased and the value-added time increased. Thus, this is an exemplary case study for the implementation of a pull system and can be used both by practitioners and researchers interested in this theme.
... Visual management tools are tools of continuous performance improvement typically used in manufacturing [1]. More recently, they have been used in the healthcare setting where they have the potential to enhance staff communication and patient flow management [2][3][4][5]. ...
Purpose:
To investigate whether the installation of electronic patient journey boards in an inpatient adult rehabilitation centre in Victoria, Australia, is associated with shorter lengths of stay for admitted adult rehabilitation patients.
Methods:
A retrospective before-after analysis of 3 259 adult inpatient rehabilitation episodes from 2013 to 2018 was performed, analysing case-mix adjusted lengths of stay.
Results:
A reduction in case-mix adjusted length of stay of 4.1 days per episode (95 % confidence interval: 2.0-6.4 days) was found. The corresponding reduction in hospital costs was estimated to be $3 738 per episode (95 % confidence interval $2 398-$4 983).
Conclusions:
Installation of electronic patient journey boards was associated with shorter lengths of stay in an inpatient adult rehabilitation centre. Additional research is needed to 1) provide further evidence of the causal effect of the boards on length of stay, and 2) investigate the mechanisms by which they reduce lengths of stay (e.g., increased currency of information, changes to procedures, remote viewing) in rehabilitation settings.
... Lean concepts have previously been applied in ACUP for process improvement activities, 6,25,35 including task scheduling for technicians 20 and facility operations. 4,19 In addition, ACUP have used Lean and other methods to support improvement and process redesign efforts, 3,13,22 some of which have focused on designing and improving cage sanitation processes. 18,38 This case study was conducted at the University of Houston (Houston, TX). ...
Although efficient sanitization is a high priority for Animal Care and Use Programs (ACUP), the cage sanitation process for animals used in biomedical research can be labor-intensive. To increase the efficiency of sanitation services provided by ACUP, the current project used the Lean Six Sigma methodology to reduce the time to sanitize mouse cages by implementing countermeasures to reduce causes of waste within this process for the Animal Care Operations (ACO) group at a leading public research university. Lean Six Sigma was selected for use in this project given its goal to make organizations' routine operations flow as smoothly and efficiently as possible and its applicability to biomedical and research settings as discussed in the literature. Through observation of the ACO's existing mouse cage sanitation process and brainstorming sessions with the ACO staff, the existing process was mapped, a baseline measurement of the current process performance was established,the process was analyzed to identify potential causes of waste, and appropriate countermeasures were implemented to improve the process. These countermeasures involved actions specifically targeted at reducing process delays, which included implementing new procedures, clarified schedules, and visual controls. As a result of this project, ACO's average mouse cage sanitation process cycle time was reduced by 35 min, and the time saved was reinvested within the ACO to provide technicians additional time to complete other valuable tasks and thus support animal research endeavors at this university.
Lean Six Sigma (LSS) is recognized as a continuous improvement methodology that enhances operational processes by reducing waste, variability, and costs, while increasing the quality of products and services. Originating in the industrial and manufacturing sectors, it has been implemented in healthcare over the past three decades to improve operational performance, costs and excellence. In animal research facilities, LSS was first reported at Seattle Children’s Hospital, where tools and methods were applied in administrative and research support services. The objective of this study was to characterize the current knowledge regarding the application of LSS tools in animal research facilities, identifying the benefits and limitations of these practices. A database search identified 227 publications, of which 11 were selected. The results showed that LSS has notable applicability and should be incorporated associated with initiatives for cultural and organizational change despite limitations as resistance to implementation and difficulty in sustainment the gains.
To facilitate the delivery of accurate and timely care to patients in complex environments, process improvement methodologies such as Lean can be very effective. Lean is a quality improvement methodology that seeks to add value for patients and employees by continuously improving processes and eliminating waste. At our institution, Lean principles were applied to improve efficiency and minimize waste in the diagnostic breast imaging reading room. This paper describes how we applied Lean principles, including plan-do-study-act testing, level-loading (heijunka), and visual management, to level the workload of the diagnostic radiologists in our practice. Implementation of these principles to improve the diagnostic workflow in breast imaging is described along with examples from our practice, including challenges and future opportunities.
Personalized Patient education is a critical factor in the healthcare service delivery as it contributes to better management of diseases and ultimately enhanced clinical outcomes. TAVI (Trans-catheter Aortic Valve Implantation) is a standard cardiac procedure for patients with severe aortic stenosis. TAVI is a minimally invasive procedure, however; this procedure is still associated with a number of considerable risks based on the condition of the patient before performing this procedure. To obtain an informed consent, it is important to appropriately inform patients and their families about the risks and benefits of TAVI. In this thesis, our research objective is to leverage digital health technologies to develop a “proof-of-concept” personalized preoperative patient education system for TAVI patients “TAVI System”. An iterative user-centered approach is used to develop the web-based TAVI system, and its knowledge content is based on digitized evidence and clinical expertise. We use a knowledge management approach to model, computerize, and integrate TAVI patient assessment to generate personalized educational messages for TAVI patients. For evaluating TAVI system, we used scenario-based evaluation to ensure the correctness of the outputs of the system based on the knowledge obtained from experts.
Health Lean Management (HLM) is usually implemented to enhance the operational performance in
health care; nevertheless, scant attention is devoted to visual control and daily accountability processes.
This paper aims at investigating how to adopt a visual management system to: plan and control patient
journey in health care operations and perform a continuous improvement process. Conducting in-depth
interviews and observations, participating in meetings and collecting documentation, the patient journey
board and daily briefngs of an Intensive Care Unit were studied and improved. In the patient journey
board, the Plan, Do and Check phases were reported, distinguishing between actual and planned actions
for the patient care. The daily meetings were organised and a continuous improvement board was also
developed to solve specifc issues (Act phase), by creating ad-hoc teams, involving the staff and reporting
transparently on the board. Operational and sociotechnical performance, before and after the adoption of
HLM, were assessed demonstrating the effectiveness and efciency of visual management tools.
