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Article
Publication date: 11 April 2023

Hesham Metwalli Mousli, Iman El Sayed, Adel Zaki and Sherif Abdelmonem

This study intends to improve the quality of venous thromboembolism (VTE) prophylaxis practices including proper VTE risk assessment and the appropriate prophylaxis measures for…

Abstract

Purpose

This study intends to improve the quality of venous thromboembolism (VTE) prophylaxis practices including proper VTE risk assessment and the appropriate prophylaxis measures for surgical urology patients.

Design/methodology/approach

The authors applied the Six-Sigma define, measure, analyze, improve and control (DMAIC) improvement methodology in a pre–post interventional study that involved all adult patients above 18 years old indicated and scheduled for urology surgical interventions including endoscopic urological surgeries in a urology specialized 60-bed hospital. The pre-intervention sample included all patients meeting the inclusion criteria over a period of six months. Post-intervention sample included all patients meeting the inclusion criteria over a period of six months. The improvement areas included both the VTE risk assessment as well as the VTE prophylaxis prescription.

Findings

DMAIC methodology has achieved a substantial sustained improvement in surgical urology VTE prophylaxis practices with an average of 70% on both levels; VTE risk assessment practices and VTE prophylaxis prescribing practices were statistically significant. The post-intervention results also showed a statistically controlled process with no special cause variations. Based on the study results, the Six-Sigma DMAIC methodology can be considered of high value when applied in healthcare clinical practice improvement projects.

Research limitations/implications

The project study includes some pitfalls that can be addressed as follows: 1. The lack of VTE rate incidence tracking. This limitation can be partly refuted when the authors conduct a literature review and explore that the VTE prophylaxis effectiveness had been proven with sufficient evidence to an extent that pushed several scientific societies to develop their own guidelines to support VTE prophylaxis. (Algattas et al., 2018). 2. Another limitation of this study can be that it handled only surgical patients and more specifically surgical urology patients. Of course, VTE prophylaxis is a crucial life-threatening problem not only for the surgical admitted patients but also for all the medical admitted patients either in hospital wards or ICUs. However, the prediction that surgical patients especially surgical urology patients are more prone to VTE development risk as they have -in several cases-two or three main additive risk factors which are age, procedure duration and malignancy in elderly men. (Tikkinen et al., 2014). So, the authors consider the study project to be a prototype that hopefully can be utilized for future study projects that will manage both other surgical specialty patients and medical patients on the national level and can track accurately and effectively report the VTE incidence rates.

Practical implications

Several recommendations can be extracted from the research project that is summarized in the following points: Paying focused attention to continuous healthcare quality improvement initiatives and projects as a main approach for healthcare improvement especially for the public health-related problems. This might be achieved through periodic region-specific or specialty-specific focus groups from which public health problems could be addressed and prioritized to be considered as a part of country healthcare campaigns regarding cost-utility and feasibility studies. The adoption of a system thinking approach in dealing with the improvement strategies; all efforts and resources are to be employed to achieve a common objective. This includes the generation of a national-wide electronic health information system that can aid in healthcare resource allocation and direct the healthcare efforts towards the most important, high-priority public health problems. Electronic national-wide health record is really an effort, and resources consuming activity, but actually, it's worth exerting efforts, and its valuable outcomes may be seen several years later. 3. Development of unified national specialized VTE prophylaxis pathways to standardize the patient-specific VTE prophylaxis plans. Standardization of healthcare pathways enables healthcare professionals to follow an evidence-based practice which will be reflected on the improvement of healthcare quality level, cost-effectiveness enhancement, and timely patient care on all levels especially in high critical areas like ER and ICU. 4. Incorporation of VTE prophylaxis costs in the universal health insurance diagnosis-related group (DRG) insurance packages and service pricing. Universal health insurance is a nationwide strategy that is aiming to cover all Egypt residents by the year 2030. Universal health insurance is being following the DRG reimbursement policy that is thought to control all the healthcare-associated costs so, the VTE prophylaxis costs shall be added as the main cost item to encourage all healthcare facilities to follow an evidence-based VTE prophylaxis pathway taking into consideration the high-risk patient categories who will definitely represent a high-cost burden on the long run if they suffer a VTE event.

Originality/value

DMAIC improvement methodology applications in healthcare are still relatively limited, especially on the clinical level. The study can be considered one of a kind in Egypt dealing with a comprehensive DMAIC methodology application on the clinical level.

Details

The TQM Journal, vol. 36 no. 2
Type: Research Article
ISSN: 1754-2731

Keywords

Article
Publication date: 12 March 2024

Natália Ransolin, Tarcisio Abreu Saurin, Robyn Clay-Williams, Carlos Torres Formoso, Frances Rapport and John Cartmill

Surgical services are settings where resilient performance (RP) is necessary to cope with a wide range of variabilities. Although RP can benefit from a supportive built…

Abstract

Purpose

Surgical services are settings where resilient performance (RP) is necessary to cope with a wide range of variabilities. Although RP can benefit from a supportive built environment (BE), prior studies have focused on the operating room, giving scant attention to support areas. This study takes a broader perspective, aiming at developing BE design knowledge supportive of RP at the surgical service as a whole.

Design/methodology/approach

Seven BE design prescriptions developed in a previous work in the context of internal logistics of hospitals, and thus addressing interactions between workspaces, were used as a point of departure. The prescriptions were used as a data analysis framework in a case study of the surgical service of a medium-sized private hospital. The scope of the study included surgical and support areas, in addition to workflows involving patients and family members, staff, equipment, sterile instruments and materials, supplies, and waste. Data collection included document analysis, observations, interviews, and meetings with hospital staff.

Findings

Results identified 60 examples of using the prescriptions, 77% of which were related to areas other than the operating rooms. The developed design knowledge is framed as a set of prescriptions, examples, and their association to workflows and areas, indicating where it should be applied.

Originality/value

The design knowledge is new in surgical services and offers guidance to both BE and logistics designers.

Details

Engineering, Construction and Architectural Management, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 0969-9988

Keywords

Book part
Publication date: 7 February 2024

Maike Tietschert, Sophie Higgins, Alex Haynes, Raffaella Sadun and Sara J. Singer

Designing and developing safe systems has been a persistent challenge in health care, and in surgical settings in particular. In efforts to promote safety, safety culture, i.e.…

Abstract

Designing and developing safe systems has been a persistent challenge in health care, and in surgical settings in particular. In efforts to promote safety, safety culture, i.e., shared values regarding safety management, is considered a key driver of high-quality, safe healthcare delivery. However, changing organizational culture so that it emphasizes and promotes safety is often an elusive goal. The Safe Surgery Checklist is an innovative tool for improving safety culture and surgical care safety, but evidence about Safe Surgery Checklist effectiveness is mixed. We examined the relationship between changes in management practices and changes in perceived safety culture during implementation of safe surgery checklists. Using a pre-posttest design and survey methods, we evaluated Safe Surgery Checklist implementation in a national sample of 42 general acute care hospitals in a leading hospital network. We measured perceived management practices among managers (n = 99) using the World Management Survey. We measured perceived preoperative safety and safety culture among clinical operating room personnel (N = 2,380 (2016); N = 1,433 (2017)) using the Safe Surgical Practice Survey. We collected data in two consecutive years. Multivariable linear regression analysis demonstrated a significant relationship between changes in management practices and overall safety culture and perceived teamwork following Safe Surgery Checklist implementation.

Details

Research and Theory to Foster Change in the Face of Grand Health Care Challenges
Type: Book
ISBN: 978-1-83797-655-3

Keywords

Open Access
Article
Publication date: 5 February 2024

Marianne Jaakkola, Soila Lemmetty, Kaija Collin, Minna Ylönen and Teuvo Antikainen

This study aims to increase the understanding of the starting points and presuppositions of organizational learning (OL) processes in a hospital’s surgical department based on the…

Abstract

Purpose

This study aims to increase the understanding of the starting points and presuppositions of organizational learning (OL) processes in a hospital’s surgical department based on the existing theory of OL and to make visible the practical possibilities of the theory in this context.

Design/methodology/approach

The study was conducted as a case study. The data were collected from personnel of the hospital’s surgical department and consisted of 26 thematic interviews. The data were analyzed using qualitative theory-driven content analysis.

Findings

This study found different starting points for both employee-oriented and organization-oriented learning processes that could potentially progress to different levels of the organization: from individuals to a wider group or from a large group to an individual. The starting point of employee-oriented learning processes was depicted as everyday life problems or situations or was based on the person’s interest. The starting points of organization-oriented learning processes were described as achieving or maintaining the organization’s expected skill levels, pursuing continuous development or pursuing the organization’s specific development needs. Different kinds of presuppositions were also located within the OL processes.

Originality/value

This study produced new practice-based knowledge about the starting points of OL processes and their presuppositions. In health-care organizations, learning is especially important due to intensive and complex changes, and this study provides empirical evidence on how to enhance learning.

Details

The Learning Organization, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 0969-6474

Keywords

Article
Publication date: 13 February 2024

Jennifer Ford, David B. Isaacks and Timothy Anderson

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…

Abstract

Purpose

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.

Design/methodology/approach

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).

Findings

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.

Practical implications

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.

Originality/value

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.

Details

The Learning Organization, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 0969-6474

Keywords

Open Access
Article
Publication date: 7 February 2023

Pasquale Giungato, Bianca Moramarco, Roberto Leonardo Rana and Caterina Tricase

International outbreak of the SARS-CoV-2 infection has fostered the Italian government to impose the FFP2 protective facial masks in closed environments, including bar…

Abstract

Purpose

International outbreak of the SARS-CoV-2 infection has fostered the Italian government to impose the FFP2 protective facial masks in closed environments, including bar, restaurants and, more in general, in the food sector. Protective facial masks are rocketing, both in mass and in costs, in the food sector imposing efforts in fostering reuse strategies and in the achievement of sustainable development goals. The scope of the present paper is to depict possible strategies in manufacturing and reuse strategies that can reduce the carbon footprint (CF) of such devices.

Design/methodology/approach

To implement circular economy strategies in the protective facial masks supply chain, it was considered significant to move towards a study of the environmental impact of such devices, and therefore a CF study has been performed on an FFP2 facial mask used in the food sector. Different materials besides the mostly used polypropylene (PP) (polyethylene (PE), polycarbonate (PC), poly (lactic acid) (PLA), cotton, polyurethane (PUR), polystyrene (PS) and nylon 6,6) and different sanitisation alternatives as reuse strategies (both laboratory and homemade static oven, ultraviolet germicidal irradiation) readily implemented have been modelled to calculate the CF of a single use of an FFP2 mask.

Findings

The production of textiles in PP, followed by disposal was the main contributor to CF of the single-use FFP2 mask, followed by packaging and transportations. PP and PE were the least impacting, PC, cotton and Nylon 6-6 of the same weight results the worst. PLA has an impact greater than PP and PE obtained from crude oil, followed by PUR and PS. Static laboratory oven obtained an 80.4% reduction of CF with respect to single use PP-made FFP2 mask, whereas homemade oven obtained a similar 82.2% reduction; UV cabinet is the best option, showing an 89.9% reduction.

Research limitations/implications

The key strategies to reduce the environmental impacts of the masks (research for new materials and reuse with sanitisation) should ensure both the retention of filtering capacities and the sanitary sterility of the reused ones. Future developments should include evaluations of textile recycling impacts, using new materials and the evaluation of the life cycle costs of the reused masks.

Practical implications

This paper intends to provide to stakeholders (producers, consumers and policy makers) the tools to choose the best option for producing and reuse environmentally friendly protective facial masks to be used in the food sector, by using both different materials and easily implemented reuse strategies.

Social implications

The reduction of the CF of protective facial masks in the food sector surely will have relevant positive effects on climate change contributing to reach the goals of reducing CO2 emissions. The food sector may promote sustainable practices and attract a niche piece of clients particularly sensible to such themes.

Originality/value

The paper has two major novelties. The first one is the assessment of the CF of a single use of an FFP2 mask made with different materials of the non-woven filtering layers; as the major contribution to the CF of FFP2 masks is related to the non-woven textiles manufacturing, the authors test some other different materials, including PLA. The second is the assessment of the CF of one single use of a sanitised FFP2 mask, using different sanitation technologies as those allowed in bars or restaurants.

Details

British Food Journal, vol. 126 no. 1
Type: Research Article
ISSN: 0007-070X

Keywords

Open Access
Article
Publication date: 26 January 2024

Alessandra Da Ros, Francesca Pennucci and Sabina De Rosis

The outbreak of the COVID-19 pandemic has significantly impacted healthcare systems, presenting unforeseen challenges that necessitated the implementation of change management…

Abstract

Purpose

The outbreak of the COVID-19 pandemic has significantly impacted healthcare systems, presenting unforeseen challenges that necessitated the implementation of change management strategies to adapt to the new contextual conditions. This study aims to analyze organizational changes within the total hip replacement (THR) surgery pathway at multiple levels, including macro, meso and micro. It employs data triangulation from various sources to gauge the complexity of the change process and comprehend how multi-level decision-making influenced an unexpected shift.

Design/methodology/approach

A multicentric, single in-depth case study was conducted using a mixed-methods approach. Data sources included patient-reported outcome measures specific to the THR pathway and carefully structured in-depth interviews administered to managers and clinicians in two healthcare organizations serving the same population.

Findings

Decisions made at the macro level resulted in an overall reduction in surgical activities. Organizational changes at the meso level led to a complete cessation or partial reorganization of activities. Micro-level actions for change and adaptation revealed diverse and fragmented change management strategies.

Practical implications

Organizations with segmented structures may require a robust and structured department for coordinating change management responses to prevent the entire system from becoming stuck in the absorptive phase of change. However, it is important to recognize that absorptive solutions can serve as a starting point for genuine innovations in change management.

Originality/value

The utilization of data triangulation enables the authors to visualize how specific changes implemented in response to the pandemic have influenced the observed outcomes. From a managerial perspective, it provides insights into how future innovations could be introduced.

Details

Management Decision, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 0025-1747

Keywords

Article
Publication date: 28 February 2023

Helen Dion and Martin Evans

The issue of energy efficiency is becoming increasingly prevalent globally due to factors such as the expansion of the population, economic growth and excessive consumption that…

1121

Abstract

Purpose

The issue of energy efficiency is becoming increasingly prevalent globally due to factors such as the expansion of the population, economic growth and excessive consumption that is not sustainable in the long run. Additionally, healthcare facilities and hospitals are facing challenges as their operational costs continue to rise. The research aim is to develop strategic frameworks for managing green hospitals, towards energy efficiency and corporate governance in hospitals and healthcare facilities.

Design/methodology/approach

This research employs a qualitative case study approach, with a sample of ten hospitals examined through interviews with senior management, executives and healthcare facilities managers. Relevant data was also collected from literature and analysed through critical appraisal and content analysis. The research methodology is based on the use of grounded theory research methodologies to build theories from case studies.

Findings

The research developed three integrated conceptual strategic frameworks for managing hospitals and healthcare facilities towards energy efficiency, green hospital initiatives and corporate governance. The research also outlined the concepts of green hospitals and energy efficiency management systems and best practices based on the conclusions drawn from the investigated case studies.

Research limitations/implications

The study is limited to the initiatives and experiences of the healthcare facilities studied in the Middle East and North Africa (MENA) region.

Originality/value

The research findings, conclusions, recommendations and proposed frameworks and concepts contribute significantly to the existing body of knowledge. This research also provides recommendations for hospital managers and policymakers on how to effectively implement and manage energy efficiency initiatives in healthcare facilities.

Details

Benchmarking: An International Journal, vol. 31 no. 2
Type: Research Article
ISSN: 1463-5771

Keywords

Abstract

Details

Knowledge Translation
Type: Book
ISBN: 978-1-80382-889-3

Open Access
Article
Publication date: 2 January 2024

Pamela David, Intan S. Zulkafli, Rasheeda Mohd Zamin, Snehlata Samberkar, Kah Hui Wong, Murali Naidu and Srijit Das

The teaching and learning of anatomy has experienced a significant paradigm shift. The present study assessed the level of knowledge in anatomy in medical postgraduate students…

Abstract

Purpose

The teaching and learning of anatomy has experienced a significant paradigm shift. The present study assessed the level of knowledge in anatomy in medical postgraduate students and explored the impact of interventions in the form of anatomical videos on knowledge obtained. An awareness of the importance of human anatomy for clinical skills was created to ensure a certain level of competence be achieved by the end of the anatomy course.

Design/methodology/approach

Postgraduate medical students were recruited from various specialties on voluntary basis. The first step was to conduct a preliminary screening exam to determine the level of anatomical knowledge. The students were then divided into two groups at random, one of which received no intervention (the control group), and the other of which watched the videos with content that was pertinent to the practical demonstrations (intervention). To assess the effects of the video intervention, a post-test was administered to all students.

Findings

Both spot tests (SPOTs) and short answer question (SAQ) components for scores of all the regions from the intervention groups were comparable to the scores obtained by the post-test control group, although the findings were not significant (p > 0.05). However, the intervention group from the abdomen (ABD) region did perform significantly better (p < 0.05) than the screening test score.

Originality/value

The results of the research study imply that interventions like anatomical videos can bridge the postgraduate trainee’s anatomy knowledge gap in a practical method which will immensely help in increasing their knowledge.

Details

Arab Gulf Journal of Scientific Research, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 1985-9899

Keywords

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