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The cost of providing healthcare is spiralling up in recent times. On the one hand, patients expect the highest quality of service, while on the other hand, the managers of the healthcare services want to minimise the total operating expenses. Hence, healthcare organisations implement lean thinking (LT) to achieve these twin objectives. LT reduces the eight wastes that are prevalent in the healthcare processes and functions. In particular, if the wasteful inventories related to expensive medical supplies are reduced, the resulting cost savings can help in providing affordable and accessible healthcare.

Hence, in this paper, a case study of a hospital is presented where LT is implemented. One of the projects was related to inventory reduction in the store of the catheterisation laboratory (cath lab). A hybrid methodology called multi-unit selective inventory control (MUSIC) that combined these three dimensions (3D), namely, consumption value, criticality and lead time or ease of availability was used to classify the medical supplies into different categories.

Based on the results obtained, various inventory systems and the associated tools and techniques of LT were proposed. For example, a deep dive into the A-class items revealed that some of the medical supplies fell under both vital and scarce categories. Hence, it was recommended that the case hospital should follow the economic order quantity (EOQ) with safety stock approach as these items were to be shipped from other states in India. Subsequently, the focus should be on developing a local supplier and attempts should be made to establish a kanban system with adequate information sharing.

This study demonstrates the step-by-step methodology of MUSIC-3D which would guide the procurement managers to apply the same in their organisation. It also helps them in identifying appropriate elements of LT for inventory reduction before the actual deployment.

None of the papers has utilised the MUSIC-3D methodology as a precursor for inventory reduction, specifically within the domain of LT. Similarly, identifying and proposing different type of inventory systems and various LT practices based on this unique method is a novel attempt.

Globally and particularly in Ireland, reduced expenditure on healthcare along with increasing pressure to increase patient throughput and improved performance against standards, is forcing healthcare providers to adopt tools from the business sector and apply them in the healthcare sector to bring about improved performance. The paper aims to discuss these issues.

This study is interpretivist in nature, specifically focussing on exploring how the balanced scorecard can support improved service delivery within a hospital department. The research will conduct an exploratory case study of a single hospital site within the Irish republic. This research is based on qualitative interviews with corroboration from document review and direct observation. This study provides a snap-shot of the Cath Lab service at a moment in time.

The development of a strategy map and proposed balanced scorecard for an Irish hospital unit.

The development of a balanced scorecard for a healthcare organisation.

Regency Hospital Limited, a multi-specialty hospital in Kanpur, India was founded by Dr. Atul Kapoor in 1995. The hospital had grown over the years. However, there were a number of issues that were yet to be dealt with. The case describes the struggles that the founder went through in setting up this hospital. It presents the challenges from the perspective of the founder as well as the staff and doctors of the hospital. In the process, the case highlights issues on leadership, entrepreneurship, organizational culture, and management of change.

This study demonstrates how becoming a high-reliability institution in health care is a priority, given the high-risk environment in which an error can result in harm. Literature conceptually supports the need for highly reliable health care facilities but does not show a comprehensive approach to operationalizing the concept into the daily workforce to support patients. The Veterans Health Administration closes the gap by documenting a case study that not only demonstrates specific actions and functions that create a high-reliability organization (HRO) for safety and improvement but also created a learning organization by spreading the knowledge to other facilities.

The authors instituted a methodology consisting of assessments, training and educational simulations to measure, establish and operationalize activities that identified and prevented harmful events. Visual communication boards were created to facilitate team huddles and discuss improvement ideas. Improvements were then measured and analyzed for purposeful outcomes and return on investment (ROI).

HRO can be operationalized successfully in health care systems. Measurable outcomes verified that psychological safety was achieved through the identification and participation of 3,184 process improvement projects over a five-year period, which yielded a US$2.8m ROI. Documented processes and activities were used for educational teachings, which were disseminated to other Veteran Affairs Medical Center’s through the Truman HRO Academy.

This case study is limited to one hospital in the Veterans Health Administration (VHA) network. As the VHA continues to deploy the methods outlined to other hospitals, the authors will perform incremental data collection and ongoing analysis for further validation of the HRO methods and operations. Hospitalists can adapt the methods in the case study for practical application in a health care setting outside of VHA. Although the model is rooted in health care, the methods may be adapted for use in other industries.

This case study overcomes the limitations within literature regarding operationalizing HRO by providing actual activities and demonstrations that can be implemented by other health care facilities.

The purpose of this paper is to explore multidisciplinary attitudes and environmental factors affecting dementia care in the Cardiac Catheter Laboratory (CCL).

Questionnaires (n=87) were distributed in a hospital CCL in the North of England. The authors utilised the Dementia Attitudes Scale which incorporates two subscales: Social Comfort and Dementia Knowledge. In addition, a newly devised questionnaire asking about perceptions of how the CCL environment affected care of patients with dementia was added.

The response rate was 71 per cent (n=62). Years’ experience in the CCL was associated with lower Social Comfort scores (p=0.026). Dementia training was associated with higher mean Dementia Attitudes Scale and Social Comfort scores (p=0.021, p=0.007). Participants who had undertaken “Professional studies” had higher Dementia Attitudes Scale and Dementia Knowledge mean scores (p=0.038, p=0.046) but “On-the-job” training was perceived as most beneficial (32 per cent, n=20). Unit co-ordinators and nurses felt the CCL was an unfavourable environment for patients with dementia. Care was perceived to be impaired by environmental functionality, equipment and the presence of ionising radiation.

The small sample limits generalisability. Although the Dementia Attitudes Scale is a validated questionnaire it has not been widely used so reliability of these results is unclear.

Caring for patients with dementia has unique challenges especially in areas like the CCL. These results suggest that practical experience and training can affect the perception of staff to patients with dementia hence there may be a need to assess what would be the most appropriate training to give health professionals in the future.

The authors believe this to be the first multi-professional research study into care of patients with dementia in a specialised acute unit. This was the most diverse sample known to have attitudes to dementia measured quantitatively in an acute hospital department and the results need to be replicated before practice should be changed.

Workflow optimisation is crucial for establishing a viable acute stroke (AS) intervention programme in a large tertiary care centre. This study aims to utilise Lean Six Sigma (LSS) principles to enhance the hospital's workflow.

The Action Research methodology was used to implement the project and develop the case study. The study took place in a large tertiary care academic hospital in India. The Define-Measure-Analyse-Improve-Control approach optimised the workflow within 6 months. Lean tools such as value stream mapping (VSM), waste audits and Gemba were utilised to identify issues involving various stakeholders in the workflow. Sigma-level calculations were used to compare baseline, improvement and sustainment status. Additionally, statistical techniques were effectively employed to draw meaningful inferences.

LSS tools and techniques can be effectively utilised in large tertiary care hospitals to optimise workflow through a structured approach. Sigma ratings of the processes showed substantial improvement, resulting in a five-fold increase in clinical outcomes. Specifically, there was a 43% improvement in outcome for patients who underwent acute stroke revascularisation. However, certain sigma ratings deteriorated during the control and extended control (sustainment) phases. This indicates that ensuring the sustainability of quality control interventions in healthcare is challenging and requires continuous auditing.

The article presents a single case study deployed in a hospital in India. Thus, the generalisation of outcomes has a significant limitation. Also, the study encounters the challenge of not having a parallel control group, which is a common limitation in quality improvement studies in healthcare. Many studies in healthcare quality improvement, including this one, are limited by minimal data on long-term follow-up and the sustainability of achieved results.

This study pioneers the integration of LSS methodologies in a large Indian tertiary care hospital, specifically targeting AS intervention. It represents the first LSS case study applied in the stroke department of any hospital in India. Whilst most case studies discuss only the positive aspects, this article fills a critical gap by unearthing the challenges of applying LSS in a complex healthcare setting, offering insights into sustainable quality improvement and operational efficiency. This case study contributes to the theoretical understanding of LSS in healthcare. It showcases its real-world impact on patient outcomes and process optimisation.

Providing public healthcare to people is a major challenge for governments. In this sector, public-funded systems are grossly inadequate in India, and excessive commercialization and exploitation by the private sector are a stark reality. The cooperative healthcare model is emerging as an alternate system in Kerala with its strong service objective to challenge the woes of private healthcare. The cooperative hospitals in the state worked round the clock to serve the poor and needy during the devastating COVID-19 pandemic. The pandemic has also badly exposed the weakness of our healthcare system in the wake of challenges posed by an increase in demand for health services, especially in rural areas. The resultant rise in the cost of treatment has put severe strains on the people at a time when even their day to day jobs were in peril. India has a strong cooperative movement and world-class institutions to serve as models in each sector. The Thrikkakara Municipal Co-operative Hospital, located at Cochin in the Kerala State of India on which this case study is written was established by the Hospital Society Ltd. in 1999, as a project under the People’s Planning Programme of the Government. Today, it has grown into a medium-sized healthcare establishment with the prime objective ‘Modern healthcare to all at affordable costs’ and cater to an average of 700 outpatients a day. This case study reveals the inception, development over years, facilities available, operations, management, public interface, and outlook for the hospital to become a modern healthcare institution to serve the people still better.