Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
5.4
Journals
IJERPH
Special Issues
Whole Systems Approaches to Process Improvement in Health Systems
ijerph-logo
Submit to IJERPH Review for IJERPH Propose a Special Issue

Journal Menu

► Journal Menu

Journal Browser

► Journal Browser
share announcement

Whole Systems Approaches to Process Improvement in Health Systems

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (31 May 2022) | Viewed by 77832

Special Issue Editors

Prof. Dr. Martin McNamara

E-Mail Website
Guest Editor
UCD Centre for Interdisciplinary Research, Education & Innovation in Health Systems, School of Nursing, Midwifery & Health Systems UCD Health Sciences Centre, Dublin D04 V1W8, Ireland
Interests: knowledge development; knowledge transmission; knowledge dissemination and translation to clinical practice; leadership development; leadership practices; innovation; innovation capacity; partnership models of curriculum design and development; interdisciplinary and interprofessional education
Dr. Marie E. Ward

E-Mail Website
Guest Editor
1. Health Systems Learning and Research, St James’s Hospital, Dublin, Ireland
2. Centre for Innovative Human Systems (CIHS), School of Psychology, Trinity College, The University of Dublin, Dublin, Ireland
Interests: human factors ergonomics; socio-technical systems; systems thinking; system change; sustainability; quality, safety and risk in healthcare and other safety critical industries; participative action research; human-centred design; co-design and co-production
Special Issues, Collections and Topics in MDPI journals
Dr. Seán Paul Teeling

E-Mail Website
Guest Editor
UCD Centre for Interdisciplinary Research, Education & Innovation in Health Systems, School of Nursing, Midwifery & Health Systems UCD Health Sciences Centre, Dublin D04 V1W8, Ireland
Interests: process improvement; quality improvement; Lean; Six Sigma; Lean Six Sigma; person-centred care; Agile; person-centredness; person-centred cultures

Special Issue Information

Dear Colleagues, 

There is currently a disconnect between innovative approaches to transforming the experience of care and service delivery, on the one hand, and improvement-based methods that focus on efficiency and clinical outcomes, on the other. All healthcare systems are required to use finite resources with greater efficiency. Combined with a focus on patients’ clinical outcomes, this tends to favour process improvement methodologies such as Lean, Six Sigma and Lean Six Sigma. There is also an increasing emphasis on improving staff and patient experiences using person-centred approaches to change. Furthermore, it is increasingly recognised that the success and sustainability of these methodologies, alone or in combination, require close attention to the impact of the structures and processes of organisational systems on their design and implementation. The papers in this supplement locate process improvement methodologies within whole systems frameworks, such as those of Oshry, Deming and Senge. The focus is on how and in what ways an appreciation of systems, when applied to the design and implementation of process improvement initiatives across a range of clinical contexts, can contribute to improvements in the staff and patient experience of providing and receiving care, and in clinical outcomes. 

We invite papers that demonstrate how process improvement initiatives take account of organizational structures and processes to enable innovation, productive partnerships and successful and sustainable improvement in health systems. 

Prof. Dr. Martin McNamara
Dr. Marie E. Ward
Dr. Seán Paul Teeling
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Systems thinking
  • Health systems
  • Process improvement
  • Person-centredness
  • Person-centred cultures
  • Lean
  • Six Sigma
  • Lean Six Sigma
  • Innovation
  • Sustainability
  • Clinical
  • Staff
  • Patients

Published Papers (19 papers)

Download All Papers
Order results
Result details
Show export options expand_more Show export options expand_less
Select all
Export citation of selected articles as:

Editorial

Jump to: Research, Review

5 pages, 296 KiB  
Editorial
Making a Sustainable Difference to People, Processes and Systems: Whole-Systems Approaches to Process Improvement in Health Systems
by Martin McNamara, Marie Ward and Seán Paul Teeling
Int. J. Environ. Res. Public Health 2023, 20(7), 5232; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20075232 - 23 Mar 2023
Cited by 2 | Viewed by 1834
Abstract
The eighteen papers in this Special Issue, ‘Whole-Systems Approaches to Process Improvement in Health Systems’, address an enduring challenge in healthcare: to improve efficiency with existing or reduced resources, while maintaining safe and effective care [...] Full article
(This article belongs to the Special Issue Whole Systems Approaches to Process Improvement in Health Systems)

Research

Jump to: Editorial, Review

11 pages, 2156 KiB  
Article
Evaluation of Waste Related to the Admission Process of Low-Complexity Patients in Emergency Services, in Light of the Lean Healthcare Philosophy
by Letícia Bianchini de Barros, Laura Passos Caldas, Elena Bohomol, Alice Sarantopoulos, Vinicius Minatogawa and Renata Cristina Gasparino
Int. J. Environ. Res. Public Health 2022, 19(12), 7044; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19127044 - 08 Jun 2022
Cited by 3 | Viewed by 1960
Abstract
The adequacy of work processes in healthcare services contributes to the quality of care provided to the patient. However, in emergency units, overcrowding is a constant reality, resulting in the lack of materials and long waiting lines. Taking this into consideration, this study [...] Read more.
The adequacy of work processes in healthcare services contributes to the quality of care provided to the patient. However, in emergency units, overcrowding is a constant reality, resulting in the lack of materials and long waiting lines. Taking this into consideration, this study aimed to map and analyze the value stream of patients classified as blue, green, or yellow in a Referral Emergency Unit. The evaluation research with analysis of processes was carried out in a teaching hospital on 30 patients seen at the emergency service. Value Stream Maps were drawn and the times involved in the process were calculated. Wastes and their possible causes were identified. A total of 13 maps were created and the mean process time between the activities involved in the process ranged between 7.3′ and 114.0′; the interruption time, between 0′ and 27.6′; the waiting time, between 43.2′ and 507.5′; and the lead time between 56.6′ and 638.0′ min. Some causes of waste were: high demand from patients; a shortage of personnel and offices. Following the Ishikawa Diagram, most of the waste is found regarding methods, human resources, and physical structure. Full article
(This article belongs to the Special Issue Whole Systems Approaches to Process Improvement in Health Systems)
►▼ Show Figures

Figure 1

20 pages, 1412 KiB  
Article
Using a Combined Lean and Person-Centred Approach to Support the Resumption of Routine Hospital Activity following the First Wave of COVID-19
by Ailish Daly, Sean Paul Teeling, Suzanne Garvey, Marie Ward and Martin McNamara
Int. J. Environ. Res. Public Health 2022, 19(5), 2754; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19052754 - 27 Feb 2022
Cited by 5 | Viewed by 2851
Abstract
The unexpected advent of the COVID-19 pandemic led to a sudden disruption of routine medical care, with a subsequent reorganization of hospital structures and of care. Case studies are becoming available in the literature referring to the logistical difficulties involved in a hospital [...] Read more.
The unexpected advent of the COVID-19 pandemic led to a sudden disruption of routine medical care, with a subsequent reorganization of hospital structures and of care. Case studies are becoming available in the literature referring to the logistical difficulties involved in a hospital resuming normal activity following the first COVID-19 lockdown period. This paper details the experience of a study site, a private hospital in Dublin, Ireland, in the redesign of service delivery in compliance with new COVID-19 prevention regulations to facilitate the resumption of routine hospital activity following the first wave of COVID-19. The aim was to resume routine activity and optimize patient activity, whilst remaining compliant with COVID-19 guidelines. We employed a pre-/post-intervention design using Lean methodology and utilised a rapid improvement event (RIE) approach underpinned by person-centred principles. This was a system-wide improvement including all hospital staff, facilitated by a specific project team including the chief operation officer, allied therapy manager (encompassing health and social care professionals), infection prevention and control team, head of surgical services, clinical nurse managers, patient services manager and the head of procurement. Following our intervention, hospital services resumed successfully, with the initial service resumption meeting the organizational target of a 75% bed occupancy rate, while the number of resumed surgeries exceeded the target by 13%. Our outpatient visits recovered to exceed the attendance numbers pre-COVID-19 in 2019 by 10%. In addition, patient satisfaction improved from 93% to 95%, and importantly, we had no in-hospital patient COVID-19 transmission in the study period of July to December 2020. Full article
(This article belongs to the Special Issue Whole Systems Approaches to Process Improvement in Health Systems)
►▼ Show Figures

Figure 1

17 pages, 3805 KiB  
Article
Developing New Methods for Person-Centred Approaches to Adjudicate Context–Mechanism–Outcome Configurations in Realist Evaluation
by Seán Paul Teeling, Jan Dewing and Deborah Baldie
Int. J. Environ. Res. Public Health 2022, 19(4), 2370; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19042370 - 18 Feb 2022
Cited by 4 | Viewed by 2679
Abstract
Realist evaluation provides a general method of evaluating the application of interventions including policy, legislation, projects, and new processes in social settings such as law enforcement, healthcare and education. Realist evaluation focuses on what about interventions works, for whom, and in what circumstances, [...] Read more.
Realist evaluation provides a general method of evaluating the application of interventions including policy, legislation, projects, and new processes in social settings such as law enforcement, healthcare and education. Realist evaluation focuses on what about interventions works, for whom, and in what circumstances, and there is a growing body of work using realist evaluation to analyse interventions in healthcare organizations, including those using Lean Six Sigma improvement methodologies. Whilst realist evaluation facilitates the analysis of interventions using both qualitative and quantitative research, there is little guidance given on methods of data collection and analysis. The purpose of this study is to address this lack of guidance through detailing the use of innovative person-centred methods of data collection and analysis in a realist evaluation that enabled us to understand the contribution of Lean Six Sigma to person-centred care and cultures. This use of person-centred principles in the adjudication of identified program theories has informed novel methods of collecting and analysing data in realist evaluation that facilitate a person-centred approach to working with research participants and a way of making the implicit explicit when adjudicating program theory. Full article
(This article belongs to the Special Issue Whole Systems Approaches to Process Improvement in Health Systems)
►▼ Show Figures

Figure 1

18 pages, 2487 KiB  
Article
The Use of Lean Six Sigma Methodology in the Reduction of Patient Length of Stay Following Anterior Cruciate Ligament Reconstruction Surgery
by Sinead Moffatt, Catherine Garry, Hannah McCann, Sean Paul Teeling, Marie Ward and Martin McNamara
Int. J. Environ. Res. Public Health 2022, 19(3), 1588; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19031588 - 30 Jan 2022
Cited by 10 | Viewed by 3245
Abstract
Background: The purpose of this study was to reduce the length of stay of anterior cruciate ligament reconstruction patients within a private hospital in Ireland, reducing any non-value-added activity in the patient pathway, with the goal of increasing patient flow, bed capacity, and [...] Read more.
Background: The purpose of this study was to reduce the length of stay of anterior cruciate ligament reconstruction patients within a private hospital in Ireland, reducing any non-value-added activity in the patient pathway, with the goal of increasing patient flow, bed capacity, and revenue generation within the hospital system, while maintaining patient satisfaction. Methods: We used a pre-/post-intervention design and Lean Six Sigma methods and tools to assess and improve the current process. Results: A reduction in inpatient length of stay by 57%, and a reduction in identified non-value-added activity by 88%, resulted in a new day-case surgery pathway for anterior cruciate ligament reconstruction patients. The pathway evidenced no re-admissions and demonstrated patient satisfaction. Conclusion: Six months post-project commencement, we had successfully achieved our goals of reducing our anterior cruciate ligament reconstruction patient’s length of stay. This study contributes to the growing body of published evidence which shows that adopting a Lean Six Sigma approach can be successfully employed to optimise care and surgical pathways in healthcare. Full article
(This article belongs to the Special Issue Whole Systems Approaches to Process Improvement in Health Systems)
►▼ Show Figures

Figure 1

22 pages, 760 KiB  
Article
A Case Study of a Whole System Approach to Improvement in an Acute Hospital Setting
by Marie E. Ward, Ailish Daly, Martin McNamara, Suzanne Garvey and Sean Paul Teeling
Int. J. Environ. Res. Public Health 2022, 19(3), 1246; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19031246 - 22 Jan 2022
Cited by 12 | Viewed by 4213
Abstract
Changes in healthcare tend to be project-based with whole system change, which acknowledges the interconnectedness of socio-technical factors, not the norm. This paper attempts to address the question of whole system change posed by the special issue and brings together other research presented [...] Read more.
Changes in healthcare tend to be project-based with whole system change, which acknowledges the interconnectedness of socio-technical factors, not the norm. This paper attempts to address the question of whole system change posed by the special issue and brings together other research presented in this special issue. A case study approach was adopted to understand the deployment of a whole system change in the acute hospital setting along four dimensions of a socio-technical systems framework: culture, system functioning, action, and sense-making. The case study demonstrates evidence of whole system improvement. The approach to change was co-designed by staff and management, projects involving staff from all specialities and levels of seniority were linked to each other and to the strategic objectives of the organisation, and learnings from first-generation projects have been passed to second and third-generation process improvements. The socio-technical systems framework was used retrospectively to assess the system change but could also be used prospectively to help healthcare organisations develop approaches to whole system improvement. Full article
(This article belongs to the Special Issue Whole Systems Approaches to Process Improvement in Health Systems)
►▼ Show Figures

Figure 1

15 pages, 348 KiB  
Article
What Does a Systems Approach to Quality Improvement Look Like in Practice?
by Sharon J. Williams and Stephanie Best
Int. J. Environ. Res. Public Health 2022, 19(2), 747; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19020747 - 10 Jan 2022
Cited by 2 | Viewed by 3326
Abstract
Universally improving healthcare systems is difficult to achieve in practice with organisations implementing a range of quality improvement (QI) approaches, in varying and changing contexts, and efforts ranging from project-based improvements to whole system change. This study aimed to identify how organisations overcome [...] Read more.
Universally improving healthcare systems is difficult to achieve in practice with organisations implementing a range of quality improvement (QI) approaches, in varying and changing contexts, and efforts ranging from project-based improvements to whole system change. This study aimed to identify how organisations overcome the challenges to improving the quality of the services they deliver. Drawing on the eight challenges from the ‘Quality and Safety in Europe by Research (QUASER) hospital guide, we assessed eight cases reported by the UK-based regulator Care Quality Commission as improving their performance. A thematic analysis of these secondary data established that all eight challenges had been addressed or considered in varying degrees. Education and physical and technological challenges seemed less prominent than developments made to address other challenges such as developing leadership, structure, and culture to support improving quality. This paper relies on the analysis of secondary case data and one framework to assess improvement efforts. Further research is required to consider other models and frameworks and to collate longitudinal data to capture the dynamics and increasing the maturity of improving healthcare systems in practice. Full article
(This article belongs to the Special Issue Whole Systems Approaches to Process Improvement in Health Systems)
13 pages, 6350 KiB  
Article
Examining the Theoretical Relationship between Constructs in the Person-Centred Practice Framework: A Structural Equation Model
by Tanya McCance, Brendan McCormack, Paul Slater and Donna McConnell
Int. J. Environ. Res. Public Health 2021, 18(24), 13138; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph182413138 - 13 Dec 2021
Cited by 15 | Viewed by 5182
Abstract
Research relating to person-centred practice continues to expand and currently there is a dearth of statistical evidence that tests the validity of an accepted model for person-centred practice. The Person-centred Practice Framework is a midrange theory that is used globally, across a range [...] Read more.
Research relating to person-centred practice continues to expand and currently there is a dearth of statistical evidence that tests the validity of an accepted model for person-centred practice. The Person-centred Practice Framework is a midrange theory that is used globally, across a range of diverse settings. The aim of this study was to statistically examine the relationships within the Person-centred Practice Framework. A cross sectional survey design using a standardized tool was used to assess a purposive sample (n = 1283, 31.8%) of multi-disciplinary health professionals across Ireland. Survey construct scores were included in a structural model to examine the theoretical model of person-centred practice. The results were drawn from a multi-disciplinary sample, and represented a broad range of clinical settings. The model explains 60.5% of the total variance. Factor loadings on the second order latent construct, along with fit statistics, confirm the acceptability of the measurement model. Statistically significant factor loadings were also acceptable. A positive, statistically significant relationship was observed between components of the Person-centred Practice Framework confirming it’s theoretical propositions. The study provides statistical evidence to support the Person-centred Practice Framework, with a multidisciplinary sample. The findings help confirm the effectiveness of the Person-Centred Practice Index for-Staff as an instrument that is theoretically aligned to an internationally recognised model for person-centred practice. Full article
(This article belongs to the Special Issue Whole Systems Approaches to Process Improvement in Health Systems)
►▼ Show Figures

Figure 1

14 pages, 1361 KiB  
Article
An Implementation Science Laboratory as One Approach to Whole System Improvement: A Canadian Healthcare Perspective
by Rachel Flynn, Stephanie P. Brooks, Denise Thomson, Gabrielle L. Zimmermann, David Johnson and Tracy Wasylak
Int. J. Environ. Res. Public Health 2021, 18(23), 12681; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph182312681 - 01 Dec 2021
Cited by 4 | Viewed by 2830
Abstract
Implementation science (IS) has emerged as an integral component for evidence-based whole system improvement. IS studies the best methods to promote the systematic uptake of evidence-based interventions into routine practice to improve the quality and effectiveness of health service delivery and patient care. [...] Read more.
Implementation science (IS) has emerged as an integral component for evidence-based whole system improvement. IS studies the best methods to promote the systematic uptake of evidence-based interventions into routine practice to improve the quality and effectiveness of health service delivery and patient care. IS laboratories (IS labs) are one mechanism to integrate implementation science as an evidence-based approach to whole system improvement and to support a learning health system. This paper aims to examine if IS labs are a suitable approach to whole system improvement. We retrospectively analyzed an existing IS lab (Alberta, Canada’s Implementation Science Collaborative) to assess the potential of IS labs to perform as a whole system approach to improvement and to identify key activities and considerations for designing IS labs specifically to support learning health systems. Results from our evaluation show the extent to which IS labs support learning health systems through enabling infrastructures for system-wide improvement and research. Full article
(This article belongs to the Special Issue Whole Systems Approaches to Process Improvement in Health Systems)
►▼ Show Figures

Figure 1

33 pages, 3009 KiB  
Article
Evaluation of an Access-Risk-Knowledge (ARK) Platform for Governance of Risk and Change in Complex Socio-Technical Systems
by Nick McDonald, Lucy McKenna, Rebecca Vining, Brian Doyle, Junli Liang, Marie E. Ward, Pernilla Ulfvengren, Una Geary, John Guilfoyle, Arwa Shuhaiber, Julio Hernandez, Mary Fogarty, Una Healy, Christopher Tallon and Rob Brennan
Int. J. Environ. Res. Public Health 2021, 18(23), 12572; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph182312572 - 29 Nov 2021
Cited by 10 | Viewed by 3531
Abstract
Three key challenges to a whole-system approach to process improvement in health systems are the complexity of socio-technical activity, the capacity to change purposefully, and the consequent capacity to proactively manage and govern the system. The literature on healthcare improvement demonstrates the persistence [...] Read more.
Three key challenges to a whole-system approach to process improvement in health systems are the complexity of socio-technical activity, the capacity to change purposefully, and the consequent capacity to proactively manage and govern the system. The literature on healthcare improvement demonstrates the persistence of these problems. In this project, the Access-Risk-Knowledge (ARK) Platform, which supports the implementation of improvement projects, was deployed across three healthcare organisations to address risk management for the prevention and control of healthcare-associated infections (HCAIs). In each organisation, quality and safety experts initiated an ARK project and participated in a follow-up survey and focus group. The platform was then evaluated against a set of fifteen needs related to complex system transformation. While the results highlighted concerns about the platform’s usability, feedback was generally positive regarding its effectiveness and potential value in supporting HCAI risk management. The ARK Platform addresses the majority of identified needs for system transformation; other needs were validated in the trial or are undergoing development. This trial provided a starting point for a knowledge-based solution to enhance organisational governance and develop shared knowledge through a Community of Practice that will contribute to sustaining and generalising that change. Full article
(This article belongs to the Special Issue Whole Systems Approaches to Process Improvement in Health Systems)
►▼ Show Figures

Figure 1

16 pages, 5048 KiB  
Article
Operation Note Transformation: The Application of Lean Six Sigma to Improve the Process of Documenting the Operation Note in a Private Hospital Setting
by Nicola Wolfe, Seán Paul Teeling, Marie Ward, Martin McNamara and Liby Koshy
Int. J. Environ. Res. Public Health 2021, 18(22), 12217; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph182212217 - 21 Nov 2021
Cited by 9 | Viewed by 3453
Abstract
Clinical documentation is a key safety and quality risk, particularly at transitions of care where there is a higher risk of information being miscommunicated or lost. A surgical operation note (ON) is an essential medicolegal document to ensure continuity of patient care between [...] Read more.
Clinical documentation is a key safety and quality risk, particularly at transitions of care where there is a higher risk of information being miscommunicated or lost. A surgical operation note (ON) is an essential medicolegal document to ensure continuity of patient care between the surgical operating team and other colleagues, which should be completed immediately following surgery. Incomplete operating surgeon documentation of the ON, in a legible and timely manner, impacts the quality of information available to nurses to deliver post-operative care. In the project site, a private hospital in Dublin, Ireland, the accuracy of completion of the ON across all surgical specialties was 20%. This project sought to improve the accuracy, legibility, and completeness of the ON in the Operating Room. A multidisciplinary team of staff utilised the Lean Six Sigma (LSS) methodology, specifically the Define/Measure/Analyse/Design/Verify (DMADV) framework, to design a new digital process application for documenting the ON. Post-introduction of the new design, 100% of the ONs were completed digitally with a corresponding cost saving of EUR 10,000 annually. The time to complete the ON was reduced by 30% due to the designed digital platform and mandatory fields, ensuring 100% of the document is legible. As a result, this project significantly improved the quality and timely production of the ON within a digital solution. The success of the newly designed ON process demonstrates the effectiveness of the DMADV in establishing a co-designed, value-adding process for post-operative surgical notes. Full article
(This article belongs to the Special Issue Whole Systems Approaches to Process Improvement in Health Systems)
►▼ Show Figures

Figure 1

15 pages, 2068 KiB  
Article
Releasing Operating Room Nursing Time to Care through the Reduction of Surgical Case Preparation Time: A Lean Six Sigma Pilot Study
by Patricia Egan, Anthony Pierce, Audrey Flynn, Sean Paul Teeling, Marie Ward and Martin McNamara
Int. J. Environ. Res. Public Health 2021, 18(22), 12098; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph182212098 - 18 Nov 2021
Cited by 11 | Viewed by 3816
Abstract
Healthcare systems internationally are working under increasing demand to use finite resources with greater efficiency. The drive for efficiency utilises process improvement methodologies such as Lean Six Sigma. This study outlines a pilot Lean Six Sigma intervention designed to release nursing time to [...] Read more.
Healthcare systems internationally are working under increasing demand to use finite resources with greater efficiency. The drive for efficiency utilises process improvement methodologies such as Lean Six Sigma. This study outlines a pilot Lean Six Sigma intervention designed to release nursing time to care within a peri-operative environment; this was achieved by collaborating with stakeholders to redesign the process for laparoscopic hernia surgical case preparation (set up) material. Across 128 laparoscopic hernia surgical cases, the pilot resulted in a 55% decrease in overall nursing time spent in gathering and preparing materials for laparoscopic hernia surgical cases, with a corresponding reduction in packaging waste. The major impact of releasing nursing time to care within busy Operating Room environments enabled nurses to focus on continuing to deliver high-quality care to their patients and reduce pressure expressed by the Operating Room nurses. The results have led to an ongoing review of other surgical procedures preparation to further release nursing time and will be of interest to perioperative teams internationally. Full article
(This article belongs to the Special Issue Whole Systems Approaches to Process Improvement in Health Systems)
►▼ Show Figures

Figure 1

15 pages, 2189 KiB  
Article
Redesigning the Process for Scheduling Elective Orthopaedic Surgery: A Combined Lean Six Sigma and Person-Centred Approach
by Ailish Daly, Nicola Wolfe, Seán Paul Teeling, Marie Ward and Martin McNamara
Int. J. Environ. Res. Public Health 2021, 18(22), 11946; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph182211946 - 13 Nov 2021
Cited by 11 | Viewed by 2851
Abstract
The Health Service Executive Ireland model of care for elective surgery supports the delivery of elective surgical care in achieving both process and clinical outcomes. This project was conducted in the Orthopaedic Department. Following an outpatient consultation with an orthopaedic surgeon, patients who [...] Read more.
The Health Service Executive Ireland model of care for elective surgery supports the delivery of elective surgical care in achieving both process and clinical outcomes. This project was conducted in the Orthopaedic Department. Following an outpatient consultation with an orthopaedic surgeon, patients who required surgical intervention were scheduled for their intervention by the administrative team. Prior to commencing this project, the average time from patient consultation to being scheduled for surgery on the hospital system was 62 h/2.58 days. A pre- and post-team-based intervention design employing Lean Six Sigma methodology was applied to redesign the process for scheduling elective orthopaedic surgery. The project was informed by collaborative, inclusive, and participatory stakeholder engagement. The goal was to streamline the scheduling process for elective orthopaedic surgery, with a target that 90% of surgeries are scheduled “right first time” within 48 h/two working days of the outpatient consultant appointment. The main outcome measures showed that 100% of orthopaedic surgeries were scheduled successfully within 2 days of outpatient appointment. Duplication in work between patient services and scheduling teams was eliminated and facilitated a reduction in unnecessary staff workload. This project highlights the importance of collaborative interdisciplinary stakeholder engagement in the redesigning of processes to achieve sustainable outcomes, and the findings have informed further improvements across the hospital’s surgical scheduling system. Full article
(This article belongs to the Special Issue Whole Systems Approaches to Process Improvement in Health Systems)
►▼ Show Figures

Figure 1

18 pages, 2164 KiB  
Article
A Rapid Realist Review of Quality Care Process Metrics Implementation in Nursing and Midwifery Practice
by Sean Paul Teeling, Carmel Davies, Marlize Barnard, Laserina O’Connor, Alice Coffey, Veronica Lambert, Martin McNamara, Dympna Tuohy, Timothy Frawley, Catherine Redmond, Suja Somanadhan, Mary Casey, Yvonne Corcoran, Owen Doody, Denise O’Brien, Maria Noonan, Rita Smith, Carmel Bradshaw, Sylvia Murphy, Liz Dore, Rosemary Lyons, Máire McGeehan and Anne Gallenadd Show full author list remove Hide full author list
Int. J. Environ. Res. Public Health 2021, 18(22), 11932; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph182211932 - 13 Nov 2021
Cited by 2 | Viewed by 3488
Abstract
Quality measurement initiatives promote quality improvement in healthcare but can be challenging to implement effectively. This paper presents a Rapid Realist Review (RRR) of published literature on Quality Care-Process Metrics (QCP-M) implementation in nursing and midwifery practice. An RRR informed by RAMESES II [...] Read more.
Quality measurement initiatives promote quality improvement in healthcare but can be challenging to implement effectively. This paper presents a Rapid Realist Review (RRR) of published literature on Quality Care-Process Metrics (QCP-M) implementation in nursing and midwifery practice. An RRR informed by RAMESES II standards was conducted as an efficient means to synthesize evidence using an expert panel. The review involved research question development, quality appraisal, data extraction, and evidence synthesis. Six program theories summarised below identify the key characteristics that promote positive outcomes in QCP-M implementation. Program Theory 1: Focuses on the evidence base and accessibility of the QCP-M and their ease of use by nurses and midwives working in busy and complex care environments. Program Theory 2: Examines the influence of external factors on QCP-M implementation. Program Theory 3: Relates to existing cultures and systems within clinical sites. Program Theory 4: Relates to nurses’ and midwives’ knowledge and beliefs. Program Theory 5: Builds on the staff theme of Programme Theory four, extending the culture of organizational learning, and highlights the meaningful engagement of nurses and midwives in the implementation process as a key characteristic of success. Program Theory 6: Relates to patient needs. The results provide nursing and midwifery policymakers and professionals with evidence-based program theory that can be translated into action-orientated strategies to help guide successful QCP-M implementation. Full article
(This article belongs to the Special Issue Whole Systems Approaches to Process Improvement in Health Systems)
►▼ Show Figures

Figure 1

18 pages, 1419 KiB  
Article
Lean Six Sigma Redesign of a Process for Healthcare Mandatory Education in Basic Life Support—A Pilot Study
by Anne Dempsey, Ciara Robinson, Niamh Moffatt, Therese Hennessy, Annmarie Bradshaw, Sean Paul Teeling, Marie Ward and Martin McNamara
Int. J. Environ. Res. Public Health 2021, 18(21), 11653; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph182111653 - 06 Nov 2021
Cited by 9 | Viewed by 4940
Abstract
Healthcare staff are required to undertake mandatory training programs to ensure they maintain key clinical competencies. This study was conducted in a private hospital in Ireland, where the processes for accessing mandatory training were found to be highly complex and non-user friendly, resulting [...] Read more.
Healthcare staff are required to undertake mandatory training programs to ensure they maintain key clinical competencies. This study was conducted in a private hospital in Ireland, where the processes for accessing mandatory training were found to be highly complex and non-user friendly, resulting in missed training opportunities, specific training license expiration, and underutilized training slots which resulted in lost time for both the trainers and trainees. A pilot study was undertaken to review the process for accessing mandatory training with a focus on the mandatory training program of Basic Life Support (BLS). This was chosen due to its importance in patient resuscitation and its requirement in the hospital achieving Joint Commission International (JCI) accreditation. A pre- and post-team-based intervention design was used with Lean Six Sigma (LSS) methodology employed to redesign the process of booking, scheduling, and delivery of BLS training leading to staff individual BLS certification for a period of two years. The redesign of the BLS training program resulted in a new blended delivery method, and the initiation of a pilot project led to a 50% increase in the volume of BLS classes and a time saving of 154 h 30 min for staff and 48 h 14 min for BLS instructors. The success of the BLS process access pilot has functioned as a platform for the redesign of other mandatory education programs and will be of interest to hospitals with mandatory training requirements that are already facing healthcare challenges and demands on staff time. Full article
(This article belongs to the Special Issue Whole Systems Approaches to Process Improvement in Health Systems)
►▼ Show Figures

Figure 1

15 pages, 9995 KiB  
Article
The Use of Lean Six Sigma for Improving Availability of and Access to Emergency Department Data to Facilitate Patient Flow
by Ailish Daly, Seán Paul Teeling, Marie Ward, Martin McNamara and Ciara Robinson
Int. J. Environ. Res. Public Health 2021, 18(21), 11030; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph182111030 - 20 Oct 2021
Cited by 10 | Viewed by 6116
Abstract
The aim of this study was to redesign an emergency department [ED] data management system to improve the availability of, and access to, data to facilitate patient flow. A pre-/post-intervention design was employed using Lean Six Sigma methodology with a focus on the [...] Read more.
The aim of this study was to redesign an emergency department [ED] data management system to improve the availability of, and access to, data to facilitate patient flow. A pre-/post-intervention design was employed using Lean Six Sigma methodology with a focus on the voice of the customer, Gemba, and 5S to identify areas for improvement in ED data management processes and to inform solutions for improved ED patient flow processes. A multidisciplinary ED team includes medical consultants and registrars, nurses, patient service staff, radiology staff, as well as information technology and hospital management staff. Lean Six Sigma [LSS] diagnostic tools identified areas for improvement in the current process for data availability and access. A set of improvements were implemented to redesign the pathway for data collection in the ED to improve data availability and access. We achieved a reduction in the time taken to access ED patient flow data from a mean of 9 min per patient pre-intervention to immediate post-intervention. This enabled faster decision-making by the ED team related to patient assessment and treatment and informed improvements in patient flow. Optimizing patient flow through a hospital’s ED is a complex task involving collaboration and participation from multiple disciplines. Through the use of LSS methodology, we improved the availability of, and fast access to, accurate, current information regarding ED patient flow. This allows ED and hospital management teams to identify and rapidly respond to actions impacting patient flow. Full article
(This article belongs to the Special Issue Whole Systems Approaches to Process Improvement in Health Systems)
►▼ Show Figures

Figure 1

14 pages, 3258 KiB  
Article
Using Lean Six Sigma to Redesign the Supply Chain to the Operating Room Department of a Private Hospital to Reduce Associated Costs and Release Nursing Time to Care
by Lisa O’Mahony, Kerrie McCarthy, Josephine O’Donoghue, Seán Paul Teeling, Marie Ward and Martin McNamara
Int. J. Environ. Res. Public Health 2021, 18(21), 11011; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph182111011 - 20 Oct 2021
Cited by 18 | Viewed by 7846
Abstract
Continuity of the supply chain is an integral element in the safe and timely delivery of health services. Lean Six Sigma (LSS), a continuous improvement approach, aims to drive efficiencies and standardisation in processes, and while well established in the manufacturing and supply [...] Read more.
Continuity of the supply chain is an integral element in the safe and timely delivery of health services. Lean Six Sigma (LSS), a continuous improvement approach, aims to drive efficiencies and standardisation in processes, and while well established in the manufacturing and supply chain industries, also has relevance in healthcare supply chain management. This study outlines the application of LSS tools and techniques within the supply chain of an Operating Room (OR) setting in a private hospital in Dublin, Ireland. A pre-/post-intervention design was employed following the Define, Measure, Analyse, Improve, Control (DMAIC) framework and applying LSS methodology to redesign the current process for stock management both within the OR storage area and within a pilot OR suite, through collaborative, inclusive, and participatory engagement with staff. A set of improvements were implemented to standardise and streamline the stock management in both areas. The main outcomes from the improvements implemented were an overall reduction in the value of stock held within the operating theatre by 17.7%, a reduction in the value of stock going out of date by 91.7%, and a reduction in the time spent by clinical staff preparing stock required for procedures by 45%, all demonstrating the effectiveness of LSS in healthcare supply chain management. Full article
(This article belongs to the Special Issue Whole Systems Approaches to Process Improvement in Health Systems)
►▼ Show Figures

Figure 1

21 pages, 4437 KiB  
Article
A Realist Inquiry to Identify the Contribution of Lean Six Sigma to Person-Centred Care and Cultures
by Seán Paul Teeling, Jan Dewing and Deborah Baldie
Int. J. Environ. Res. Public Health 2021, 18(19), 10427; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph181910427 - 03 Oct 2021
Cited by 11 | Viewed by 3899
Abstract
A lack of fidelity to Lean Six Sigma’s (LSS) philosophical roots can create division between person-centred approaches to transforming care experiences and services, and system wide quality improvement methods focused solely on efficiency and clinical outcomes. There is little research into, and a [...] Read more.
A lack of fidelity to Lean Six Sigma’s (LSS) philosophical roots can create division between person-centred approaches to transforming care experiences and services, and system wide quality improvement methods focused solely on efficiency and clinical outcomes. There is little research into, and a poor understanding of, the mechanisms and processes through which LSS education influences healthcare staffs’ person-centred practice. This realist inquiry asks ‘whether, to what extent and in what ways, LSS in healthcare contributes to person-centred care and cultures’. Realist review identified three potential Context, Mechanism, Outcome configurations (CMOcs) explaining how LSS influenced practice, relating to staff, patients, and organisational influences. Realist evaluation was used to explore the CMOc relating to staff, showing how they interacted with a LSS education Programme (the intervention) with CMOc adjudication by the research team and study participants to determine whether, to what extent, and in what ways it influenced person-centred cultures. Three more focused CMOcs emerged from the adjudication of the CMOc relating to staff, and these were aligned to previously identified synergies and divergences between participants’ LSS practice and person-centred cultures. This enabled us to understand the contribution of LSS to person-centred care and cultures that contribute to the evidence base on the study of quality improvement beyond intervention effectiveness alone. Full article
(This article belongs to the Special Issue Whole Systems Approaches to Process Improvement in Health Systems)
►▼ Show Figures

Figure 1

Review

Jump to: Editorial, Research

20 pages, 1183 KiB  
Review
Discrete-Event Simulation Modeling in Healthcare: A Comprehensive Review
by Jesús Isaac Vázquez-Serrano, Rodrigo E. Peimbert-García and Leopoldo Eduardo Cárdenas-Barrón
Int. J. Environ. Res. Public Health 2021, 18(22), 12262; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph182212262 - 22 Nov 2021
Cited by 41 | Viewed by 6323
Abstract
Discrete-event simulation (DES) is a stochastic modeling approach widely used to address dynamic and complex systems, such as healthcare. In this review, academic databases were systematically searched to identify 231 papers focused on DES modeling in healthcare. These studies were sorted by year, [...] Read more.
Discrete-event simulation (DES) is a stochastic modeling approach widely used to address dynamic and complex systems, such as healthcare. In this review, academic databases were systematically searched to identify 231 papers focused on DES modeling in healthcare. These studies were sorted by year, approach, healthcare setting, outcome, provenance, and software use. Among the surveys, conceptual/theoretical studies, reviews, and case studies, it was found that almost two-thirds of the theoretical articles discuss models that include DES along with other analytical techniques, such as optimization and lean/six sigma, and one-third of the applications were carried out in more than one healthcare setting, with emergency departments being the most popular. Moreover, half of the applications seek to improve time- and efficiency-related metrics, and one-third of all papers use hybrid models. Finally, the most popular DES software is Arena and Simul8. Overall, there is an increasing trend towards using DES in healthcare to address issues at an operational level, yet less than 10% of DES applications present actual implementations following the modeling stage. Thus, future research should focus on the implementation of the models to assess their impact on healthcare processes, patients, and, possibly, their clinical value. Other areas are DES studies that emphasize their methodological formulation, as well as the development of frameworks for hybrid models. Full article
(This article belongs to the Special Issue Whole Systems Approaches to Process Improvement in Health Systems)
►▼ Show Figures

Figure 1

Show export options expand_more Show export options expand_less
Select all
Export citation of selected articles as:
 
Displaying articles 1-19
Back to TopTop