Industrial improvement approaches such as Lean management are increasingly being adopted in health care. Synthesis is necessary to ensure these approaches are evidence based and requires operationalization of concepts to ensure all relevant studies are included. This article outlines the process utilized to develop an operational definition of Lean in health care. The literature search, screening, data extraction, and data synthesis processes followed the recommendations outlined by the Cochrane Collaboration. Development of the operational definition utilized the methods prescribed by Kinsman et al. and Wieland et al. This involved extracting characteristics of Lean, synthesizing similar components to establish an operational definition, applying this definition, and updating the definition to address shortcomings. We identified two defining characteristics of Lean health-care management: (1) Lean philosophy, consisting of Lean principles and continuous improvement, and (2) Lean activities, which include Lean assessment activities and Lean improvement activities. The resulting operational definition requires that an organization or subunit of an organization had integrated Lean philosophy into the organization’s mandate, guidelines, or policies and utilized at least one Lean assessment activity or Lean improvement activity. This operational definition of Lean management in health care will act as an objective screening criterion for our systematic review. To our knowledge, this is the first evidence-based operational definition of Lean management in health care.
This article introduces the development and theoretical underpinnings of family-involved treatment for alcoholism against a backdrop of major theories of addiction. It describes several interventions from the family therapy literature in relation to Prochaska, DiClemente, and Norcross's model of change, with an emphasis on behavioral techniques. It also outlines efficacy research and considers some problems with the family approach. Although the lack of agreement regarding theory and practice may be the most salient difficulty for the field, the discussion further reveals an inconsistency between the tenets of the family systems paradigm and behaviorally-based family interventions. It suggests that the family approach should expand its scope of analysis and challenges researchers to incorporate additional techniques from diverse perspectives.
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:• To assess effects of Lean management in health care on patient, professional, and systems outcomes by addressing the following question.
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: • To assess effects of Lean management in health care on patient, professional, and systems outcomes by addressing the following question. Lean management in health care: effects on patient outcomes, professional practice, and healthcare systems (Protocol)
Background: Many organizations have adopted Lean tools to improve healthcare, but few studies adequately evaluate the effectiveness of Lean tools, such as Rapid Process Improvement Workshops (RPIWs).Objective: To evaluate the effectiveness of RPIWs conducted in surgical services at two hospital sites from economic and statistical perspectives.Methods: Retrospective data over three years from the two interventions sites were used for a cost-benefit analysis in the form of Return on Investment (ROI). The Interrupted Time Series (ITS) method was used to analyze the trends of selected process measures such as surgical volumes, overtime, and sick time hours during intervention and post-intervention periods at the two sites. Also, comparable data from two control sites were used to statistically compare the trends of some of the process measures between the intervention and control sites.Results: The cumulative effects of the six RPIWs performed at each site were examined. The results did not produce any evidence to indicate that the outcomes justify the investments. The ITS analysis revealed no indication of systematic and sustained change in the pattern of process measures at the intervention sites as a result of RPIWs. Nor did they provide significant or conclusive evidence when comparing the process measures between the intervention and control sites.Conclusions: This study identifies some of the difficulties of empirically calculating the ROI of RPIWs, and provides evidence that any realized benefits due to RPIWs implemented in two hospitals were not worth the investment. Such a result may lead us to challenge any unfounded claims of high monetary benefits from Lean tools or similar quality improvement initiatives.
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