Search results

Two different systems for streaming patients were considered to improve efficiency measures such as waiting times (WTs) and length of stay (LOS) for a current emergency department (ED). A typical fast track area (FTA) and a fast track with a wait time threshold (FTW) were designed and compared effectiveness measures from the perspective of total opportunity cost of all patients’ WTs in the ED. The paper aims to discuss these issues.

This retrospective case study used computerized ED patient arrival to discharge time logs (between July 1, 2009 and June 30, 2010) to build computer simulation models for the FTA and fast track with wait time threshold systems. Various wait time thresholds were applied to stream different acuity-level patients. National average wait time for each acuity level was considered as a threshold to stream patients.

The fast track with a wait time threshold (FTW) showed a statistically significant shorter total wait time than the current system or a typical FTA system. The patient streaming management would improve the service quality of the ED as well as patients’ opportunity costs by reducing the total LOS in the ED.

The results of this study were based on computer simulation models with some assumptions such as no transfer times between processes, an arrival distribution of patients, and no deviation of flow pattern.

When the streaming of patient flow can be managed based on the wait time before being seen by a physician, it is possible for patients to see a physician within a tolerable wait time, which would result in less crowded in the ED.

A new streaming scheme of patients’ flow may improve the performance of fast track system.

This paper aims to describe the integrating and disintegrating effects of professional actions in customised care.

Using a qualitative case study, the authors examine the work practices and cultures of three Swedish child and adolescent psychiatric care units (CAP) charged with providing customised care in collaboration with other organisations. The authors conducted 62 interviews, made 11 half‐day observations, and shadowed employees for two days.

The social embeddedness of action is crucial to understanding the professions' integrating/disintegrating activities. In the internal social context of CAP, the professions adapt to productivity‐enhancing new public management (NPM) principles, resulting in integrating effects between the different professions and administrative management in the CAP units. However, CAP exercises professional dominance over the cooperating organisations. Thus, in the external social context, CAP's resistance to customised care principles exacerbates the disintegration problems among the different organisations.

The study concludes that, contrary to findings in many other studies, neither the professional logic nor NPM/customised care reforms determine the actions of professionals. In this case, the institutionalisation of some NPM methods blocks the adoption of customised care practices.

Contrary to the widely accepted idea that resource restriction is a main source of conflict between management and the professions, the professions accept and adapt to resource restrictions, even at the expense of de‐emphasising the practices of customised care. Thus, since professionals choose different operational strategies depending on the social context, the success of a normative reform measure may depend in part on its social context.

Facilitated by a decision support system tool, the purpose of this paper is to find the “best” allocated number of surgeons and medicine doctors that reduce patients' non‐value‐added time (NVAT) and total time in the system (TTS).

Interview and observation are first conducted in order to get general insights about (and to understand) the emergency ward of Sahlgrenska Hospital in Gothenburg (Sweden) and its value stream (flow). Then, time‐related data are collected by conducting time measurements empirically and through the triage database. The statistics of the collected empirical data represent the initial state of the system and are utilised as the input of ARENA^® simulation. A simulation scenario is designed by constructing a 3×3 table (= nine combinations) that contains a varying number of surgeons and medicine doctors allocated in the emergency ward. For each combination, 1,000 replications apply (=10 runs @ 100 replications). “Runs” are the cycles or how many times the simulation is executed, while “replications” refer to how many times a computer (automatically) repeats the simulation in a single execution. The simulation length of a single replication was set at 24 hours due to the fact that an emergency ward was always open. The selected feasible solution is the “best” combination of surgeons and medicine doctors that reduces the existing NVAT and TTS while ensuring that the resource utilisation is at a “reasonable” level (and did not exceed 100 per cent).

The simulation output indicates that the emergency ward may achieve considerable reduction in a patients' NVAT and total patients' time in the system by assigning three medicine doctors and three surgeons. This combination leads to (in average) 13 per cent reduction of NVAT while maintaining the TTS at approximately the same level.

An expanded simulation model with a higher level of complexity and ability to accommodate, e.g. cost of care, flow/layout reconfiguration would be greatly needed and is of interest. It would also be relevant to add greater flexibility by assigning more parameters in the simulation model (other than medicine doctor and surgeon).

Simulation can be considered as a valuable decision‐support tool in the adoption of lean in healthcare due to its flexibility in the sense that it is able to show the output (outcome) of various scenarios before any actual change is made. The results of our study present another side of the adoption of lean thinking besides layoff.

Increased demand and the pressure to reduce health-care costs have led to longer waiting time for patients to make appointments and during the day of hospital visits. The purpose of this study is to identify opportunities to reduce waiting time using lean techniques and discrete-event simulation (DES).

A five-step procedure is proposed to facilitate the effective utilization of lean and DES to improve the performance of the Otolaryngology Head and Neck Surgery Outpatient Clinic at Cleveland Clinic Abu Dhabi. While lean techniques were applied to reduce the potential sources of waste by aligning processes, a DES model was developed to validate the proposed solutions and plan patient arrivals under dynamic conditions and different scenarios.

Aligning processes resulted in an efficient patient flow reducing both waiting times. DES played a complementary role in verifying lean solutions under dynamic conditions, helping to plan the patient arrivals and striking a balance between the waiting times. The proposed solutions offered flexibility to improve the clinic capacity from the current 176 patients up to 479 (without violating the 30 min waiting time policy) or to reduce the patient waiting time during the visit from the current 33 min to 4.5 min (without violating the capacity goal of 333 patients).

Proposing and validating lean solutions require reliable data to be collected from the clinic and such a process could be laborious as data collection require patient and resource tracing without interfering with the regular functions of the clinic.

The work enables health-care managers to conveniently conduct a trade-off analysis and choose a suitable inter-arrival time – for every physician – that would satisfy their objectives between resource utilization (clinic capacity) and average patient waiting time.

Successful implementation of lean requires a supportive and cooperative culture from all stakeholders involved.

This study presents an original and detailed application of lean techniques with DES to reduce patient waiting times. The adopted approach in this study could be generalized to other health-care settings with similar objectives.

The purpose of this study is to document the experience and impact of implementing lean thinking (LT) in an Indian healthcare institution.

A detailed review of literature documenting the experience of implementing LT in healthcare institutions is carried out. Review revealed that there is a dearth of documentation on implementation of LT in Indian healthcare institutions. To address this gap, the experience of implementing LT in an Indian case hospital is documented by adopting a single case study research methodology.

Lean practices adopted by the Indian case hospital are documented. Performance measures before and after implementation of lean practices in the case hospital are compared. Based on this experience, a framework for implementing LT is proposed for healthcare institutions.

The current study documents the experience of an Indian case hospital, which is only at its initial stages of LT implementation. Future studies can be undertaken to assess the long-term impact of implementing LT in a healthcare institution. Similarly, the proposed framework for implementing LT can be validated by using the same in different healthcare institutions.

Review of lean principles, practices and performance measures discussed in the literature on implementing LT in healthcare institutions can act as a ready reckoner for practitioners. Framework proposed based on the experience of the case hospital is expected to guide healthcare practitioners in their lean journey.

This study is unique, as it documents the experience of implementing LT in an Indian healthcare institution and proposes a framework for implementing LT for future validation.

Tremendous measure of data lakes with the exponential mounting rate is produced by the present healthcare sector. The information from differing sources like electronic wellbeing record, clinical information, streaming information from sensors, biomedical image data, biomedical signal information, lab data, and so on brand it substantial as well as mind-boggling as far as changing information positions, which have stressed the abilities of prevailing regular database frameworks in terms of scalability, storage of unstructured data, concurrency, and cost. Big data solutions step in the picture by harnessing these colossal, assorted, and multipart data indexes to accomplish progressively important and learned patterns. The reconciliation of multimodal information seeking after removing the relationship among the unstructured information types is a hotly debated issue these days. Big data energizes in triumphing the bits of knowledge from these immense expanses of information. Big data is a term which is required to take care of the issues of volume, velocity, and variety generally seated in the medicinal services data. This work plans to exhibit a survey of the writing of big data arrangements in the medicinal services part, the potential changes, challenges, and accessible stages and philosophies to execute enormous information investigation in the healthcare sector. The work categories the big healthcare data (BHD) applications in five broad categories, followed by a prolific review of each sphere, and also offers some practical available real-life applications of BHD solutions.

Overcrowding in emergency departments (EDs) leads to longer waiting times and results in higher number of patients leaving the ED without being seen by a physician. EDs need to improve quality for patients’ waiting time and length of stay (LoS) from the perspective of process and flow control management. The paper aims to discuss these issues.

The retrospective case study was performed using the computerized ED patient time logs from arrival to discharge between July 1, 2009 and June 30, 2010. Patients were divided into two groups either adult or pediatric with a cutoff age of 18. Patients’ characteristics were measured by arrival time periods, waiting times before being seen by a physician, total LoS and acuity levels. A discrete event simulation was applied to the comparison of quality performance measures.

Statistically significant differences were found between the two groups in terms of arrival times, acuity levels, waiting time stratified for various arrival times and acuity levels. The process quality for pediatric patients could be improved by redesign of patient flow management and medical resource.

The results are limited to a case of one community and ED. This study did not analyze the characteristic of leaving the ED without being seen by a physician.

Separation of pediatric patients from adult patients in an ED can reduce the waiting time before being seen by a physician and the total staying time in the ED for pediatric patients. It can also lessen the chances for pediatric patients to leave the ED without being seen by a physician.

A process and flow control management scheme based on patient group characteristics may improve service quality and lead to a better patient satisfaction in ED.

In Wales (United Kingdom (UK)), a programme known as the emergency department quality and delivery framework (EDQDF) was launched in 2018 with the purpose of designing a framework of what good looks like for emergency care and then implementing this framework in a measurable and sustainable way.

A gatekeeper emailed attendees of the EDQDF launch event (n = 70), providing recipients with an information sheet and inviting them to contact the researcher (KJ) if they agreed to be interviewed. The authors conducted semi-structured interviews with all respondents (n = 8) after three invitation rounds sent between August and October 2021. The authors used a thematic analysis approach (Braun and Clarke, 2006).

Participants agreed with the aims and design of the framework, and the authors identified four themes relating to barriers and to facilitators of implementation. Participants perceive a softening of geographical boundaries through the project, but findings correspond with evidence generated elsewhere regarding emergency departments’ (EDs') system-wide interdependencies and a need for cross-organisational collaboration.

A quality improvement method for health services known as CAREMORE® is found to be a useful approach for the collaborative design of service improvements. Participants perceive a softening of geographical boundaries through the project, but the interviews correspond with evidence generated elsewhere regarding EDs' system-wide interdependencies and a need for cross-organisational collaboration.

This evaluation relies on a relatively small number of participants, but as a qualitative evaluation it does not aim towards broadly generalisable findings but rather contributes to broad field concerned with the production of knowledge on the implementation of health service improvements. The project under evaluation is also on-going, and the findings reflect the period from inception to December 2021, but not beyond that date.

This evaluation builds upon previous work in relation to the application of CAREMORE to design a quality improvement framework in a complex area (see Nelson et al., 2018), but this evaluation considers the implementation process. The findings echo research elsewhere and add to a growing body of research that underlines system interconnectivities that impact upon the emergency department.

The purpose of this paper is to systematically investigate the patient flow and waiting time problems in hospital emergency departments (EDs) from an integrated voice of customer (VOC) and voice of process (VOP) perspective and to propose a new lean framework for ED process.

A survey was conducted to better understand patients' perceptions of ED services, lean tools such as process mapping and A3 problem-solving sheets were used to identify hidden process wastes and root-cause analysis was performed to determine the reasons of long waiting time in ED.

The results indicate that long waiting times in ED are major concerns for patients and affect the quality of ED services. It was revealed that limited bed capacity, unavailability of necessary staff, layout of ED, lack of understanding among patients about the nature of emergency services are main causes of delay. Addressing these issues using lean tools, integrated with the VOC and VOP perspectives can lead to improved patient flow, higher patient satisfaction and improvement in ED capacity. A future value stream map is proposed to streamline the ED activities and minimize waiting times.

The research involves a relatively small sample from a single case study. The proposed approach will enable the ED administrators to avoid the ED overcrowding and streamline the entire ED process.

This research identified ED quality issues from the integration of VOC and VOP perspective and suggested appropriate lean tools to overcome these problems. This process improvement approach will enable the ED administrators to improve productivity and performance of hospitals.

The purpose of this paper is to explain how different emergency services adopt and adapt the same hospital-wide lean-inspired intervention and how this is reflected in hospital process performance data.

A multiple case study based on a realistic evaluation approach to identify mechanisms for how lean impacts process performance and services’ capability to learn and continually improve. Four years of process performance data were collected from seven emergency services at a Swedish University Hospital: ear, nose and throat (ENT) (two), pediatrics (two), gynecology, internal medicine, and surgery. Performance patterns were linked with qualitative data collected through realist interviews.

The complexity of the care process influenced how improvement in access to care was achieved. For less complex care processes (ENT and gynecology), large and sustained improvement was mainly the result of a better match between capacity and demand. For medicine, surgery, and pediatrics, which exhibit greater care process complexity, sustainable, or continual improvement were constrained because the changes implemented were insufficient in addressing the higher degree of complexity.

The variation in process performance and sustainability of results indicate that lean efforts should be carefully adapted to the complexity of the care process and to the educational commitment of healthcare organizations. Ultimately, the ability to adapt lean to a particular context of application depends on the development of routines that effectively support learning from daily practices.