Search results

The goal was to improve the quality of the hospitalization process and the management of patients, allowing the reduction of costs and the minimization of the preoperative Length of Hospital Stay (LOS).

The methodology used to improve the quality of the hospitalization process and patient management was Lean Thinking. Therefore, the Lean tools (Value stream map and Ishikawa diagram) were used to identify waste and inefficiencies, improving the process with the implementation of corrective actions. The data was collected through personal observations, patient interviews, brainstorming and from printed medical records of 151 patients undergoing oral cancer surgery in the period from 2006 to 2018.

The authors identified, through Value Stream Map, waste and inefficiencies during preoperative activities, consequently influencing preoperative LOS, considered the best performance indicator. The main causes were identified through the Ishikawa diagram, allowing reflection on possible solutions. The main corrective action was the introduction of the pre-hospitalization service. A comparative statistical analysis showed the significance of the solutions implemented. The average preoperative LOS decreased from 4.90 to 3.80 days (−22.40%) with a p-value of 0.001.

The methodology allowed to highlight the improvement of the patient hospitalization process with the introduction of the pre-hospitalization service. Therefore, by adopting the culture of continuous improvement, the flow of hospitalization was redrawn. The benefits of the solutions implemented are addressed to the patient in terms of lower LOS and greater service satisfaction and to the hospital for lower patient management costs and improved process quality. This article will be useful for those who need examples on how to apply Lean tools in healthcare.

Cardiovascular diseases are the leading cause of death worldwide. In Italy, acute myocardial infarction (AMI) is a major cause of hospitalization and healthcare costs. AMI is a myocardial necrosis event caused by an unstable ischemic syndrome. The Italian government has defined an indicator called “AMI: 30-day mortality” to assess the quality of the overall care pathway of the heart attacked patient. In order to guarantee high standards, all hospitals had to implement techniques to increase the quality of care pathway. The aim of the paper is to identify the root cause and understand the mortality rate for AMI and redesign the patient management process in order to improve it.

A Lean Six Sigma (LSS) approach was used in this study to analyze the patient flow in order to reduce 30-days mortality rate from AMI registered by Complex Operative Unit (COU) of Cardiology of an Italian hospital. Value stream mapping (VSM) and Ishikawa diagrams were implemented as tools of analysis.

Process improvement using LSS methodology made it possible to reduce the overall times from 115 minutes to 75 minutes, with a reduction of 35%. In addition, the corrective actions such as the activation of a post-discharge outpatient clinic and telephone contacts allowed the 30-day mortality rate to be lowered from 16% before the project to 8% after the project. In this way, the limit value set by the Italian government was reached.

The limitation of the study is that it is single-centered and was applied to a facility with a limited number of cases.

The LSS approach has brought significant benefits to the process of managing patients with AMI. Corrective actions such as the activation of an effective shared protocol or telephone interview with checklist can become the gold standard in reducing mortality. The limitation of the study is that it is single-centered and was applied to a facility with a limited number of cases.

LSS, applied for the first time to the management of cardiovascular diseases in Italy, is a methodology which has proved to be strategic for the improvement of healthcare process. The simple solutions implemented could serve as a guide for other hospitals to pursue the national AMI mortality target.

The study proposes Material Flow Analysis (MFA) methodology as a tool to measure and qualify food waste in the Italian beef supply chain in each stage of the food supply chain, from farm to fork. In particular, the authors attempt to: (1) measure resources consumption and waste generation toward companies' and policymakers' sustainable evaluations; (2) enhance consumers' education in the field of agri-food resilience and sustainability.

MFA is applied to the entire Italian sector of beef consumed as packaged fresh product in 2020, during the Covid-19 pandemic. The analysis regards bovine, which represent roughly one-third of the national meat flow. To collect data, bottom-up and top-down mixed approach is applied. Subsequently, MFA results are used to calculate the wastage-related losses in terms of embedded natural resources (e.g. water, energy).

In 2020, it results that the Italian meat industry slaughtered more than 1.15 Mt of bovine to produce approximately 0.29 Mt of fresh meat, 0.69 Mt of by-products and over 0.015 Mt of food waste at households, while 0.15 Mt of beef meat is destined to catering services and food industry (out-of-boundaries). In terms of hidden natural resources, it emerged that, on average, more than 94bn m3 of water, approximately 101,000 TJ of energy and over 11,500 t of PET and PE trays are required to sustain the entire beef system.

This research is one of the few studies proposing MFA methodology as a tool to measure food waste and hidden associated flows in the agri-food sector. This analysis shows its utility in terms of natural resources (water, energy, materials) and waste quality/quantity evaluation, hidden flows accounting and development of new educational strategies toward food waste minimization and sustainability at household consumption.

This study aims to examine a hierarchical framework for sustainable consumption (SC) for cruise ships and identify the causal relationships and decisive attributes of cruise ship operation practices that allow cruise organizations to achieve a higher level of sustainable performance.

This study applies a hybrid of the Delphi method and a fuzzy decision-making trial and evaluation laboratory (DEMATEL). DEMATEL methodology helps to construct complex causal relations through digraphs, which depict interrelationships among attributes. The fuzzy set theory assesses experts’ perceptions of attributes given in linguistic preferences. The Delphi method has been previously used to validate attributes and determine the validity and reliability of the construct from qualitative information.

A set of three aspects containing 21 criteria were defined based on previous literature and expert consultations. The analysis results show that waste minimization and recycling and recovery are causal aspects that influence efficient resource use. Emission controls on ships, cruise ship alternative energy sources, ballast water treatment systems, water purification systems and nanofiltration systems are also prominent criteria for the improvement of SC during cruise ship operation.

This study contributes to the literature by offering a hierarchical framework for SC literature and confirming the role of this issue in improving the cruise industry sustainability. In practice, as such results provide key attributes for successful performance, the implications are offered for companies developing new activities, either in ensuring compliance with business goals or in decreasing the environmental impact.

This study aims to offer a research overview of circular food waste management, covering key themes and trends. It analyses state-of-the-art research in this field and proposes an agenda to guide future research.

This study outlines bibliometric analysis from a sample of 349 articles with VOSviewer and SciMat software to identify research trend topics.

The findings reveal a substantial amount of interest in this field. The main research topics relate to the recovery processes and valorisation of food waste and its conversion into renewable and cleaner materials or energy sources, towards circularity. However, these processes require consideration of social aspects that facilitate their implementation, which are currently under-researched.

Companies can target their circular food waste management by considering three key aspects. Firstly, the establishment of closer and more sustainable relationships with various stakeholders; Secondly, a regulatory framework and the support of institutions are both required for the correct implementation of circularity. Finally, what is not measured does not exist. It is therefore necessary to establish indicators to measure both the level of development of circularity in waste management and the fulfilment of the established objective.

This bibliometric analysis looks at the application of circularity principles in food waste management from a holistic perspective, considering different areas of knowledge.

Given the importance of food waste in the economic, social, health and environmental dimensions, the purpose of this work is to detect, through a systematic and configurative literature review on food-waste-measurement methodologies, the global approaches, characteristics, limitations, opportunities and results applied within the literature. The analysis of these papers provides useful information about how far we are from international action plans and, therefore, how we need to direct programs and policies to measure and reduce food waste and ensure food security and food safety.

The authors have conducted a systematic, configurative literature review on food waste measurement methodologies applied only within empirical studies published in academic peer-reviewed scientific journals. Based on the Commission Delegated Decision (EU) 2019/1597 of May 3, 2019 (OJEU, 2019) regarding common methodologies and minimum quality requirements for the homogeneous assessment of food waste quantities and composition, the authors investigated the issue on Web of Science Core Collection (WoS) from June 2000 to June 2020. The authors researched keywords within article titles, abstracts and author keywords by utilizing 34 different research strings.

The proposed review particularly refers to following topics: measurement methodologies applied according to the Commission Delegated Decision (EU) 2019/1597; editorial placement and publication timeline; geographical area; food supply-chain stage and publication journals; and the main features, limitations, opportunities and results for each measurement methodology as presented by authors. Among the first 48,000 results, only 58 academic articles are perfectly in line with the aim of the review, highlighting the lack of standardized methodologies, the limits of those proposed and the deficiency of comparable results to achieve sustainable international goals.

The proposed review is one of the few concerning food waste measurement methodologies. Food waste measurement is essential to rebalance the actual inadequate food system and to switch it toward a fair, healthy and environmentally friendly one, thereby (1) managing the human nutrition system paradox of hungry, undernourished and over-weight people; (2) reducing food insecurity; (3) ensuring each living being's access to healthy, nutritious and sustainable food; and (4) reducing environmental impacts (neutral or positive impact) and the loss of biodiversity and mitigating climate change.

Improving productivity and efficiency has always been crucial for industrial companies to remain competitive. In recent years, the topic of environmental impact has become increasingly important. Published research indicates that environmental and economic goals can enforce or rival each other. However, few papers have been published that address the interaction and integration of these two goals.

In this paper, we identify both, synergies and trade-offs based on a systematic review incorporating 66 publications issued between 1992 and 2021. We analyze, quantify and cluster examples of conjunctions of ecological and economic measures and thereby develop a framework for the combined improvement of performance and environmental compatibility.

Our findings indicate an increased significance of a combined consideration of these two dimensions of sustainability. We found that cases where enforcing synergies between economic and ecological effects were identified are by far more frequent than reports on trade-offs. For the individual categories, cost savings are uniformly considered as the most important economic aspect while, energy savings appear to be marginally more relevant than waste reduction in terms of environmental aspects.

No previous literature review provides a comparable graphical treatment of synergies and trade-offs between cost savings and ecological effects. For the first time, identified measures were classified in a 3 × 3 table considering type and principle.

The purpose of this paper is to propose a system dynamic simulated process model for maintenance work management incorporating the Fourth Industrial Revolution (4IR) technologies.

The extant literature in physical assets maintenance depicts that poor maintenance management is predominantly because of a lack of a clearly defined maintenance work management process model, resulting in poor management of maintenance work. This paper solves this complex phenomenon using a combination of conceptual process modeling and system dynamics simulation incorporating 4IR technologies. A process for maintenance work management and its control actions on scheduled maintenance tasks versus unscheduled maintenance tasks is modeled, replicating real-world scenarios with a digital lens (4IR technologies) for predictive maintenance strategy.

A process for maintenance work management is thus modeled and simulated as a dynamic system. Post-model validation, this study reveals that the real-world maintenance work management process can be replicated using system dynamics modeling. The impact analysis of 4IR technologies on maintenance work management systems reveals that the implementation of 4IR technologies intensifies asset performance with an overall gain of 27.46%, yielding the best maintenance index. This study further reveals that the benefits of 4IR technologies positively impact equipment defect predictability before failure, thereby yielding a predictive maintenance strategy.

The study focused on maintenance work management system without the consideration of other subsystems such as cost of maintenance, production dynamics, and supply chain management.

The maintenance real-world quantitative data is retrieved from two maintenance departments from company A, for a period of 24 months, representing years 2017 and 2018. The maintenance quantitative data retrieved represent six various types of equipment used at underground Mines. The maintenance management qualitative data (Organizational documents) in maintenance management are retrieved from company A and company B. Company A is a global mining industry, and company B is a global manufacturing industry. The reliability of the data used in the model validation have practical implications on how maintenance work management system behaves with the benefit of 4IR technologies' implementation.

This research study yields an overall benefit in asset management, thereby intensifying asset performance. The expected learnings are intended to benefit future research in the physical asset management field of study and most important to the industry practitioners in physical asset management.

This paper provides for a model in which maintenance work and its dynamics is systematically managed. Uncontrollable corrective maintenance work increases the complexity of the overall maintenance work management. The use of a system dynamic model and simulation incorporating 4IR technologies adds value on the maintenance work management effectiveness.

The purpose of this paper is to present a theoretical framework for capacity building in post disaster construction and demolition (C & D) waste management at a national level to address the identified capacity gaps in managing disaster waste resulting from natural hazards.

Data were gathered through pilot interviews, case studies and expert opinion surveys representing government, non-government and other sector organisations involved in post disaster waste management.

The study revealed unavailability of a single point of responsibility and provision for disaster waste in existing policies and capacity constraints in prevailing peace time solid waste management practices which were identified as major capacity gaps. Establishment of a regulatory body and enforceable rules and regulations with necessary levels of capacities was identified and presented in a theoretical framework comprising of seven identified areas for capacity building in post disaster waste management.

This study is limited to disaster C & D waste as debris generated from totally or partially damaged buildings and infrastructure as a direct impact of natural hazards or from demolished buildings and infrastructure at rehabilitation or early recovery stages. Waste generated during reconstruction phase of post disaster management cycle is not considered as disaster C & D waste for purposes of this study.

The research enabled analysis of existing capacities and presents approaches for capacity building for identified gaps in post disaster C & D waste management to attain sustainable post disaster waste management for future resilience.